Prior treatment with dipeptidyl peptidase 4 inhibitors is associated with better functional outcome and lower in-hospital mortality in patients with type 2 diabetes mellitus admitted with acute ischaemic stroke

Abstract

It is unclear whether prior antidiabetic treatment affects stroke severity and outcome. To evaluate this association, we prospectively studied all patients who were admitted in our Department with acute ischaemic stroke (n = 378, mean age = 78.8 ± 6.5 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale. The outcome was assessed with the modified Rankin Scale at discharge and with in-hospital mortality. A total of 123 patients had type 2 diabetes mellitus. At admission, there was a trend for lower National Institutes of Health Stroke Scale in patients treated with dipeptidyl peptidase 4 inhibitors compared with patients treated with other antidiabetic agents (6.1 ± 7.5 vs 10.0 ± 9.2, respectively; p = 0.079). At discharge, patients treated with dipeptidyl peptidase 4 inhibitors had lower modified Rankin Scale than patients treated with other antidiabetic agents (2.1 ± 1.9 vs 3.2 ± 2.1, respectively; p < 0.05). Patients treated with dipeptidyl peptidase 4 inhibitors also had lower in-hospital mortality than patients treated with other antidiabetic agents (0.0% vs 15.1%, respectively; p < 0.05). In conclusion, prior treatment with dipeptidyl peptidase 4 inhibitors in patients with acute ischaemic stroke appears to be associated with better functional outcome and lower mortality risk.

Gliptin‐mediated neuroprotection against stroke requires chronic pretreatment and is independent of glucagon‐like peptide‐1 receptor

“…A recent prospective human study has shown that prior treatment with gliptins is associated with better functional outcome and lower mortality in stroke patients with T2D . This observation is supported by recent preclinical results that have shown a strong neuroprotective action of the gliptin linagliptin in normal mice and mice with T2D, where chronic DPP‐4 inhibition before (4 weeks) and after (3 weeks) experimental stroke reduced brain damage .…”

Incretin-Based Antihyperglycemic Agents for the Management of Acute Ischemic Stroke in Patients with Diabetes Mellitus: A Review

“…Despite these promising results of preclinical studies, there are very few data regarding the role of DPP-4 inhibitors in improving the outcome of patients with acute ischemic stroke. In a small study ( n = 123), we reported that patients who were hospitalized with acute ischemic stroke and were treated with DPP-4 inhibitors prior to stroke had a trend for less severe stroke at admission and also had better functional outcome and lower in-hospital mortality than patients treated with other antihyperglycemic agents [ 50 ].…”

Assessed and Emerging Biomarkers in Stroke and Training-Mediated Stroke Recovery: State of the Art

“…Rat models showed that PEDF induces the production of inflammatory chemokines such as MIP-2 and MIP-3 α in microglia [136]. The myokine dipeptidyl-peptidase 4 (DPP4) has recently come in the spotlight because its inhibition, as well as the use of glucagon-like receptor 1 (GLP-1) agonists, leads to an antistroke effect [137, 138] and a cardioprotective role [139]. During physical exercise, DPP4 inhibitors improve mitochondrial biogenesis and muscle activity through the activation of GLP-1 signaling [140].…”