Department of Neurology, Medisch Spectrum Twente, Koningsplein 1, Enschede, Overijssel 7512 KZ, the Netherlands.
Department of Neurology, Medisch Spectrum Twente, Koningsplein 1, Enschede, Overijssel 7512 KZ, the Netherlands.
J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106648. doi: 10.1016/j.jstrokecerebrovasdis.2022.106648. Epub 2022 Jul 18.
Diabetes mellitus is a well-known risk factor for ischemic stroke and is associated with unfavorable outcome after stroke. Metformin is recommended as first-line treatment in these patients. Pre-stroke metformin use might have neuroprotective properties resulting in reduced stroke severity. However, results of the effects of pre-stroke metformin use on functional outcome are conflicting and has not been previously described in patients with type 2 diabetes mellitus regardless of stroke severity or revascularization treatment. In this study, we aimed to assess the association between metformin use and functional outcome in patients with type 2 diabetes mellitus and acute ischemic stroke.
We used data from patients with known type 2 diabetes mellitus who were admitted with acute ischemic stroke between 2017 and 2021 in the Isala Hospital Zwolle and Medisch Spectrum Twente (MST) Enschede, the Netherlands. The association between pre-stroke metformin use and favorable functional outcome at 3 months (defined as modified Rankin Scale (mRS) < 3) was expressed as Odds Ratios (ORs) with corresponding confidence intervals (CIs). Adjustments were made for age, sex, hyperglycemia on admission and revascularization treatment by means of multiple logistic regression.
Nine hundred thirty seven patients were included of whom 592 patients (63%) used metformin. Six hundred seventy eight (74%) patients were hyperglycemic on admission. Median mRS was 3 (IQR 2-6) and 593 patients (63%) had a favorable outcome. Pre-stroke metformin use was associated with favorable outcome (aOR of 1.94 (95%- CI 1.45-2.59)).
In this study, we showed that pre-stroke metformin use was associated with favorable outcome after acute ischemic stroke in patients with diabetes mellitus type 2.
糖尿病是缺血性中风的已知危险因素，并与中风后的不良预后相关。二甲双胍被推荐作为这些患者的一线治疗药物。在中风前使用二甲双胍可能具有神经保护作用，从而降低中风的严重程度。然而，在中风前使用二甲双胍对功能结局的影响的结果存在争议，并且以前在无论中风严重程度或再通治疗如何的 2 型糖尿病患者中都没有描述过。在这项研究中，我们旨在评估 2 型糖尿病伴急性缺血性中风患者中使用二甲双胍与功能结局之间的关系。
我们使用了 2017 年至 2021 年间在荷兰伊斯拉尔医院兹沃勒和医疗频谱特温特（MST）恩斯赫德因急性缺血性中风入院的已知 2 型糖尿病患者的数据。使用多变量逻辑回归，通过调整年龄、性别、入院时高血糖和再通治疗，将中风前使用二甲双胍与 3 个月时的良好功能结局（定义为改良 Rankin 量表（mRS）<3）之间的关联表示为比值比（OR）及其相应的置信区间（CI）。
共纳入 937 例患者，其中 592 例（63%）患者使用二甲双胍。678 例（74%）患者入院时血糖升高。mRS 中位数为 3（IQR 2-6），593 例（63%）患者结局良好。中风前使用二甲双胍与良好结局相关（OR 为 1.94（95%CI 1.45-2.59））。
在这项研究中，我们表明在 2 型糖尿病患者中，急性缺血性中风前使用二甲双胍与预后良好相关。
