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

Lim, S., Oh, T. J., Dawson, J. and Sattar, N. (2020) Diabetes drugs and stroke risk: intensive versus conventional glucose‐lowering strategies, and implications of recent cardiovascular outcome trials. Diabetes, Obesity and Metabolism, 22(1), pp. 6-15. (doi: 10.1111/dom.13850) (PMID:31379119)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Dawson, Professor Jesse and Sattar, Professor Naveed
Authors: Lim, S., Oh, T. J., Dawson, J., and Sattar, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Diabetes, Obesity and Metabolism
Publisher:Wiley
ISSN:1462-8902
ISSN (Online):1463-1326
Published Online:05 August 2019

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