Impact of glucose-lowering therapies on risk of stroke in type 2 diabetes

Diabetes & Metabolism
F Bonnet, A J Scheen

Abstract

Patients with type 2 diabetes (T2D) have an increased risk of stroke compared with people without diabetes. However, the effects of glucose-lowering drugs on risk of ischaemic stroke in T2D have been less extensively investigated than in coronary heart disease. Some evidence, including the UKPDS, has suggested a reduced risk of stroke with metformin, although the number of studies is limited. Inhibition of the KATP channels increases ischaemic brain lesions in animals. This is in agreement with a recent meta-analysis showing an increased risk of stroke with sulphonylureas vs. various comparators as both mono- and combination therapy. Pioglitazone can prevent recurrence of stroke in patients with previous stroke, as already shown in PROactive, although results are less clear for first strokes. As for DPP-4 inhibitors, there was a non-significant trend towards benefit for stroke, whereas a possible increased risk of stroke with SGLT2 inhibitors-and in particular, empagliflozin in the EMPA-REG OUTCOME trial-has been suggested and requires clarification. Experimental results support a potential protective effect of GLP-1 receptor agonists against stroke that has, at least in part, been translated to clinical benefits in T2D patient...Continue Reading

Citations

Oct 10, 2019·Archives of Physiology and Biochemistry·Maxim Yu SinitskyAnastasia V Ponasenko
Sep 22, 2019·Medicina·Cristina-Mihaela LăcătușuBogdan-Mircea Mihai
Sep 27, 2018·Drugs·Antonis A ManolisAntonis S Manolis
Apr 9, 2020·Alzheimer's Research & Therapy·Carmen Hierro-BujalanceMonica Garcia-Alloza
Dec 11, 2020·Journal of Diabetes·Zachary Bloomgarden, Robert Chilton
Mar 14, 2021·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Fotios BarkasHaralampos Milionis
Oct 26, 2021·Journal of Controlled Release : Official Journal of the Controlled Release Society·Wei ChenZahid Hussain

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