Association of glucose-lowering drugs with incident stroke and transient ischaemic attacks in primary care patients with type 2 diabetes: disease analyzer database

Rathmann, Wolfgang; Kostev, Karel

doi:10.1007/s00592-022-01943-7

Cited by 8 publications

(6 citation statements)

References 36 publications

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“…Since the range of variation in body height in a given population is usually small, a large number of events is required for reliable risk assessment. The IQVIA DA database used for the analyses in this study has already been validated by several studies [ 23 ] and previously used in studies on body height [ 24 , 25 ] and diabetes mellitus [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Data are anonymously transferred to IQVIA on a regular basis, and the quality of these data is assessed using several criteria, such as completeness of documentation and linkage between diagnoses and prescriptions. The DA database has been shown to be representative for general and specialized practices in Germany [ 23 ] and was previously published in several studies focusing on body height [ 24 , 25 ] as well as diabetes mellitus [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

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Adult Body Height Is Associated with the Risk of Type 2 but Not Type 1 Diabetes Mellitus: A Retrospective Cohort Study of 783,029 Individuals in Germany

Loosen

Krieg

Krieg³

et al. 2023

JCM

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Background: Diabetes mellitus is a major global health burden associated with high morbidity and mortality. Although a short adult body height has been associated with increased risk of type 2 diabetes (T2D), there are large inconsistencies between the studies. Therefore, we aimed to investigate the association between body height and T2D in a large cohort of adult outpatients in Germany. Methods: A total of 783,029 adult outpatients with available body height data from the Disease Analyzer (IQVIA) database were included in Germany between 2010 and 2020. The incidence of diabetes mellitus (type 1 and type 2) was evaluated as a function of the patients’ body height stratified by age, sex, and body-mass-index (BMI). Results: In both women and men in all age groups, incidence of T2D decreased with the increasing body height (<50, 51–60, 61–70, and >70 years). There was no association between the body height and the individual HbA1c value. In multivariable Cox regression analyses adjusted for patient age and BMI, hazard ratios for the development of T2D were 1.15 (95% CI: 1.13–1.17) for each 10 cm decrease in body height in women and 1.10 (95% CI: 1.09–1.12) in men. No significant association was found between body height and the development of T1D. Conclusions: We present the first data from a large cohort of outpatients in Germany, providing strong evidence for an association between adult body height and T2D. These data add to the current literature and might help in implementing body height into existing diabetes risk stratification tools to further reduce morbidity and mortality worldwide.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Adult Body Height Is Associated with the Risk of Type 2 but Not Type 1 Diabetes Mellitus: A Retrospective Cohort Study of 783,029 Individuals in Germany

Loosen

Krieg

Krieg³

et al. 2023

JCM

Self Cite

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“…It appears that our findings differ because the included article in our study compared MET combination therapy with MET + SU, rather than directly contrasting it with MET monotherapy. Otherwise, the American Diabetes Association and the European Association for the Study of Diabetes [ 79 ] recommend SGLT2-i or GLP-1RA as hypoglycemic agents for patients at high risk of cardiovascular disease, and studies [ 11 ] have shown that SGLT2-i or GLP-1RA may reduce the risk of stroke in patients with T2DM. Nonetheless, given the limited number of articles included, there is not adequate evidence to conclusively support these findings.…”

Section: Disscussionmentioning

confidence: 99%

“…Recent studies indicate a predictive relationship between T2DM microvascular complications such as diabetic nephropathy (DN), DR, diabetic neuropathy, and the likelihood of stroke [ 10 ]. Furthermore, emerging evidence recognizes the cardiovascular protective properties of novel hypoglycemic drugs like sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) [ 11 ]. However, the existing body of research on stroke causation in T2DM patients exhibits variations in focus, population demographics, sample sizes, and consequent disparate findings.…”

Section: Introductionmentioning

confidence: 99%

Influencing factors of stroke in patients with type 2 diabetes: A systematic review and meta-analysis

Zhao,

Dong,

Chen

et al. 2024

PLoS ONE

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Background Stroke stands as a significant macrovascular complication among individuals with Type 2 diabetes mellitus (T2DM), often resulting in the primary cause of mortality and disability within this patient demographic. Presently, numerous studies have been conducted to investigate the underlying causes of stroke in individuals with T2DM, yet the findings exhibit inconsistencies. Objective This paper aims to consolidate and summarize the available evidence concerning the influential factors contributing to stroke among patients diagnosed with T2DM. Methods We conducted a comprehensive search across multiple databases, including Cochrane Library, PubMed, Web Of Science, Embase, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang and Weipu up to August 2023. Google Scholar was also searched to retrieve gray literature. We calculated odds ratios (OR) and 95% confidence intervals (CI) using Stata software. Results Our analysis encompassed 43 observational studies, exploring factors across sociodemographic, biochemical, complications, and hypoglycemic agent categories. The findings identified several risk factors for stroke in patients with T2DM: age, gender, T2DM duration, hypertension, body-mass index (BMI), smoking, Glycated hemoglobin (HbA1c), estimated Glomerular Filtration Rate (eGFR), albuminuria, Triglycerides (TG), Low density lipoprotein cholesterol (LDL-C), Coronary heart disease (CHD), Atrial fibrillation (AF), diabetic retinopathy (DR), Peripheral vascular disease (PVD), and carotid plaque. Conversely, exercise, High density lipoprotein cholesterol (HDL-C), metformin (MET), pioglitazone, and metformin combination therapy emerged as protective factors. Conclusion This study underscores the multitude of influencing factors contributing to stroke in people with T2DM patients, among which the microvascular complications of T2DM play an most important role. Therefore, we emphasize the importance of screening for microvascular complications in patients with T2DM. However, due to limitations arising from the number of articles reviewed, there remain areas where clarity is lacking. Further research efforts are warranted to expand upon and reinforce our current findings.

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“…Data from real-world studies showed significant risk reductions for stroke with SGLT2 inhibitor use. [3][4][5] That said, some of these studies did not distinguish ischaemic strokes from the other stroke subtypes and a meta-analysis of randomized controlled trials on stroke subtypes suggests that a protective effect from SGLT2 inhibitors is only observed for haemorrhagic strokes. 6 Further studies are required to determine the association between SGLT2 inhibitors and ischaemic strokes, in view of the conflicting results.…”

mentioning

confidence: 99%

Response to letter from Du et al. regarding article ‘Sodium‐glucose cotransporter‐2 inhibitor use was associated with lower risks of stroke and cardiac arrest but not ventricular arrhythmias?’

Fawzy

Rivera-Caravaca

Fauchier

et al. 2022

Diabetes Obesity Metabolism

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We thank Du and colleagues 1 for their interest in our paper, which investigated the impact of on sodium glucose co-transporter 2 (SGLT2) inhibitors on the various cardiovascular outcomes. 2 They highlight that glucagon-like peptide-1 receptor antagonists (GLP-1RAs), which have been linked with stroke risk reduction, were not specifically considered in the analysis. The authors also speculated that the lower incidence of stroke observed in the SGLT2 inhibitor group was probably because of the confounding effects of GLP-1RAs, further attributing the other beneficial observations to the influence of these drugs.To address this, the analysis was re-run, this time evaluating GLP-1RAs as well. As TriNetX is a real-time database with an expanding research network, the number of participating health care organizations had increased from the 57 in our original study to 64 sites by the time the analysis was re-run in September 2022.Consequently, the number of patients in each of the groups had increased, offering an even larger sample size. In total, 126 606 and 2 322 585 patients were identified in the SGLT2 and non-SGLT2 inhibitor groups respectively, with 125 088 in each group after propensity score-matching (PSM). The methodology described in our initial paper was followed but patients on ertugliflozin, in addition to those on dapagliflozin, empagliflozin and canagliflozin were now also included in the SGLT2 inhibitor group. Furthermore, transient ischaemic attacks and the composite of incident strokes/transient ischaemic attacks were additionally evaluated as outcomes of interest.Overall, our findings were consistent with our initial results, although some variations in effect size were observed. For all-cause mortality, the hazard ratio was even lower at 0.53 [95% confidence interval (CI) 0.50-0.55], suggesting that the mortality risk was almost twice as high with SGLT2 inhibitor non-use. For ischaemic strokes, the hazard ratio was 0.84 (95% CI 0.81-0.87), indicating a 16% lower risk of strokes in patients on SGLT2 inhibitors. For the composite outcome of ischaemic strokes/transient ischaemic attacks a significantly

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Association of glucose-lowering drugs with incident stroke and transient ischaemic attacks in primary care patients with type 2 diabetes: disease analyzer database

Cited by 8 publications

References 36 publications

Adult Body Height Is Associated with the Risk of Type 2 but Not Type 1 Diabetes Mellitus: A Retrospective Cohort Study of 783,029 Individuals in Germany

Adult Body Height Is Associated with the Risk of Type 2 but Not Type 1 Diabetes Mellitus: A Retrospective Cohort Study of 783,029 Individuals in Germany

Influencing factors of stroke in patients with type 2 diabetes: A systematic review and meta-analysis

Response to letter from Du et al. regarding article ‘Sodium‐glucose cotransporter‐2 inhibitor use was associated with lower risks of stroke and cardiac arrest but not ventricular arrhythmias?’

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