Moelgg Kurt, Karisik Anel, Scherer Lukas, Buergi Lucie, Dejakum Benjamin, Komarek Silvia, Granna Julian, Boehme Christian, Pechlaner Raimund, Toell Thomas, Knoflach Michael, Kiechl Stefan, Kaser Susanne, Egger Alexander, Griesmacher Andrea, Mayer-Suess Lukas
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria.
Eur Stroke J. 2025 Jan 7:23969873241304301. doi: 10.1177/23969873241304301.
The progression of diabetes status in post-stroke patients remains under-investigated, particularly regarding new treatments for type II diabetes mellitus (DM II), like glucagon-like peptide 1 receptor agonists (GLP-1-RA) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, which have not been studied in the post-stroke setting.
Eight hundred eighty-four consecutive ischemic stroke patients recruited to our prospective STROKE-CARD Registry were assessed concerning their glycemic status at baseline (normoglycemia, prediabetes, DM II) and change over time within 1 year follow-up. Multivariate logistic regression was performed to identify factors associated with transitioning from normoglycemia to prediabetes or DM II. Additionally, we reviewed ongoing clinical trials for GLP-1-RA and SGLT-2 inhibitors in the context of acute ischemic stroke.
At baseline, 44.6% ( = 394) of individuals had normoglycemia, 33.9% ( = 300) were prediabetic, and 21.5% had DM II ( = 190). After 1 year, normoglycemia decreased by 12.1 percentage points ( = 107), whereas prediabetes and DM II increased by 10.2 percentage ( = 90) points and 1.9 percentage points ( = 17), respectively. Statin therapy was the only significant risk factor for progression. 23.4% ( = 207) of our cohort would have met eligibility criteria for a recent trial on semaglutide in obese non-diabetics with prior cardiovascular disease. However, only one ongoing trial aims at evaluating short-term cardiovascular risk reduction in stroke patients.
GPrediabetes and DM II are frequent in ischemic stroke patients. Even within an intensified post-stroke disease management setting, a considerable amount of stroke survivors convert to prediabetes or DM II within the first year. Our results demonstrate a notable proportion of patients qualifying inclusion in studies examining the efficacy of GLP-1-RA agonists and SGLT-2 inhibitors in secondary prevention.
Given the high prevalence and progression of prediabetes and DM II in stroke survivors, there is a need for clinical trials evaluating the use of GLP-1-RA and SGLT-2 inhibitors in this population.
中风后患者糖尿病状态的进展仍未得到充分研究，尤其是关于II型糖尿病（DM II）的新治疗方法，如胰高血糖素样肽1受体激动剂（GLP-1-RA）和钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂，这些在中风后的情况下尚未得到研究。
对纳入我们前瞻性中风-心脏注册研究的884例连续性缺血性中风患者在基线时（血糖正常、糖尿病前期、DM II）的血糖状态以及1年随访期间随时间的变化进行了评估。进行多变量逻辑回归以确定与从血糖正常转变为糖尿病前期或DM II相关的因素。此外，我们回顾了在急性缺血性中风背景下正在进行的关于GLP-1-RA和SGLT-2抑制剂的临床试验。
在基线时，44.6%（n = 394）的个体血糖正常，33.9%（n = 300）处于糖尿病前期，21.5%患有DM II（n = 190）。1年后，血糖正常者减少了12.1个百分点（n = 107），而糖尿病前期和DM II分别增加了10.2个百分点（n = 90）和1.9个百分点（n = 17）。他汀类药物治疗是进展的唯一显著危险因素。我们队列中的23.4%（n = 207）符合最近一项关于司美格鲁肽治疗有心血管疾病史的肥胖非糖尿病患者试验的入选标准。然而，只有一项正在进行的试验旨在评估中风患者短期心血管风险的降低情况。
糖尿病前期和DM II在缺血性中风患者中很常见。即使在强化的中风后疾病管理环境中，相当数量的中风幸存者在第一年内会转变为糖尿病前期或DM II。我们的结果表明，有相当比例的患者符合纳入研究GLP-1-RA激动剂和SGLT-2抑制剂在二级预防中疗效研究的条件。
鉴于中风幸存者中糖尿病前期和DM II的高患病率及进展情况，需要进行临床试验来评估GLP-1-RA和SGLT-2抑制剂在该人群中的应用。
