Blood glucose, antidiabetic drugs, and risk of stroke

• Main Authors: Meng Lee, Bruce Ovbiagele
• Format: Article
• Language: English
• Published: Sungkyunkwan University School of Medi 2021-03-01
• Series: Precision and Future Medicine
• Subjects: blood glucose; hypoglycemic agents; stroke
• Online Access: http://www.pfmjournal.org/upload/pdf/pfm-2020-00156.pdf

Diabetes mellitus is a well-established risk factor for stroke. Among people without baseline diabetes or cardiovascular disease, a low fasting glucose level of < 70 mg/dL is associated with an increased risk of stroke. Individuals with pre-diabetes based on impaired glucose tolerance have an independent risk of stroke that is 20% greater than those with normal glycemia. Pre-diabetes based on a more recent guideline recommended definition of impaired fasting glucose (100 to 125 mg/dL) is not linked to future stroke risk, while fasting glucose 110 to 125 mg/dL is linked to an increased stroke risk. Despite the relationship between elevated blood glucose and stroke risk, lowering blood glucose with oral antidiabetic drugs is usually not associated with reduced cardiovascular events. Yet, among high cardiovascular risk patients on background metformin therapy, subcutaneous semaglutide/dulaglutide reduces future stroke risk; and among ischemic stroke patients with insulin resistance, prediabetes, and diabetes mellitus, pioglitazone lowers risks of recurrent stroke and major vascular events. Pending the conduct of definitive randomized controlled trials, a combination of metformin, pioglitazone and an sodium-glucose co-transporter 2 inhibitor or a combination of metformin, pioglitazone and subcutaneous semaglutide/dulaglutide might be reasonable therapeutic strategies for reducing secondary stroke risk in diabetic patients.