Abstract
Background: The current AHA stroke prevention guidelines give Class 1 recommendations that patients with AIS and diabetes should receive glucose-lowering agents with cardiovascular benefit to reduce risk of MACE. The ADA recommends in patients with ASCVD, when prevention of further vascular events is the priority, a GLP1RA should be added; and when concern for heart failure or chronic kidney disease is the priority, a SGLT2i should be added. Objective: Among a cohort of patients with diabetes presenting with AIS, we analyzed rates of GLP1RA and SGLT2i use during hospitalization and/or outpatient follow-up. Methods: A retrospective review of AIS patients at a comprehensive stroke center between May 2016 and October 2022 was conducted using an institutional registry. Patients were identified to have diabetes as derived by the Charlson Comorbidity Index ICD 10 codes E10 through E14. We then identified patients receiving GLP1RA or SGLT2i and evaluated trends over time. Results: 4131 patients were identified of which 2045 (49.4%) had a diagnosis of diabetes. Of these patients 60/2045 (2.9%) were on GLP1RA while 35/2045 (1.7%) were on SGTLi for total of 4.6%. Annual trends were 2016 6/220 (2.7%) and 1/220 (0.4%), in 2017 6/347 (1.7%) and 3/347 (0.8%), in 2018 6/377 (1.6%) and 5/377 (1.3%), in 2019 3/240 (1.2%) and 1/240 (0.4%), in 2020 9/335 (2.7%) and 10/335 (3.0%), in 2021 11/322 (3.4%) and 10/322 (3.1%), in 2022 19/205 (9.2%) and 5/205 (2.4%) for GLP1RA and SGLT2i, respectively. Conclusions: In this retrospective analysis of 4131 AIS cases, use of GLP1RA and SGLT2i prior to 2019 remained around 2-3%. Following publication of the 2021 stroke prevention guidelines, GLP1RA use increased in 2022 to 9%. However, the study highlights the still-low rates of use of secondary MACE prevention despite Class 1 recommendations. This analysis serves as a call to attention that improving treatment of diabetes with ASCVD risk-reduction is a potential area of improvement.
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