Diabetes drugs and stroke risk: Intensive versus conventional glucose-lowering strategies, and implications of recent cardiovascular outcome trials

Soo Lim, Tae Jung Oh, Jesse Dawson, Naveed Sattar

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

People with diabetes mellitus are at higher risk of ischaemic stroke and worse outcomes thereafter. However, whether it is better to prescribe intensive glucose-lowering treatment compared with conventional treatment in people with diabetes to prevent recurrent stroke is debated. It is also crucial to consider whether specific antidiabetic agents are more efficacious and safer than others for prevention of stroke. In this review, we provide an overview of the efficacy of intensive and conventional glucose-lowering treatment in post-stroke management. Our conclusion is that the overall evidence for a beneficial effect of intensive glycaemic control on risk of stroke is limited. We also discuss evidence from recent large clinical trials of thiazolidinediones and new antidiabetic medications, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and sodium-glucose co-transporter-2 inhibitors. On the basis of the findings of these trials, our conclusion is that pioglitazone and the GLP-1RA class (other than short-acting lixisenatide) are likely to lessen the occurrence of cerebrovascular disease (by mechanisms not dependent on glucose-lowering per se), whereas there is no consistent evidence for other drug classes.

Original languageEnglish
Pages (from-to)6-15
Number of pages10
JournalDiabetes, Obesity and Metabolism
Volume22
Issue number1
DOIs
StatePublished - 1 Jan 2020

Fingerprint

Stroke
Glucose
Pharmaceutical Preparations
pioglitazone
Hypoglycemic Agents
Sodium-Glucose Transporter 2
Dipeptidyl-Peptidase IV Inhibitors
Symporters
Cerebrovascular Disorders
Thiazolidinediones
Diabetes Mellitus
Clinical Trials

Keywords

  • cardiovascular outcome trial
  • diabetes mellitus
  • glucagon-like peptide-1 receptor agonist
  • sodium-glucose co-transporter-2 inhibitor
  • stroke

Cite this

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abstract = "People with diabetes mellitus are at higher risk of ischaemic stroke and worse outcomes thereafter. However, whether it is better to prescribe intensive glucose-lowering treatment compared with conventional treatment in people with diabetes to prevent recurrent stroke is debated. It is also crucial to consider whether specific antidiabetic agents are more efficacious and safer than others for prevention of stroke. In this review, we provide an overview of the efficacy of intensive and conventional glucose-lowering treatment in post-stroke management. Our conclusion is that the overall evidence for a beneficial effect of intensive glycaemic control on risk of stroke is limited. We also discuss evidence from recent large clinical trials of thiazolidinediones and new antidiabetic medications, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and sodium-glucose co-transporter-2 inhibitors. On the basis of the findings of these trials, our conclusion is that pioglitazone and the GLP-1RA class (other than short-acting lixisenatide) are likely to lessen the occurrence of cerebrovascular disease (by mechanisms not dependent on glucose-lowering per se), whereas there is no consistent evidence for other drug classes.",
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Diabetes drugs and stroke risk : Intensive versus conventional glucose-lowering strategies, and implications of recent cardiovascular outcome trials. / Lim, Soo; Oh, Tae Jung; Dawson, Jesse; Sattar, Naveed.

In: Diabetes, Obesity and Metabolism, Vol. 22, No. 1, 01.01.2020, p. 6-15.

Research output: Contribution to journalReview article

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