Abstract：
OBJECTIVE: This nationwide cohort study evaluated the impact of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on patients with type 2 diabetes mellitus (T2DM) after ischaemic stroke (IS), aiming to compare clinical outcomes between SGLT2i-treated patients and those not receiving SGLT2i.
METHODS: Utilizing Taiwan\'s National Health Insurance Research Database, we identified 707 patients with T2DM treated with SGLT2i and 27 514 patients not treated with SGLT2i after an IS, respectively, from 1 May 2016 to 31 December 2019. Propensity score matching was applied to balance baseline characteristics. The follow-up period extended from the index date (3 months after the index acute IS) until the independent occurrence of the study outcomes, 6 months after discontinuation of the index drug, or the end of the study period (31 December 2020), whichever came first.
RESULTS: After propensity score matching, compared with the non-SGLT2i group (n = 2813), the SGLT2i group (n = 707) exhibited significantly lower recurrent IS rates (3.605% per year vs. 5.897% per year; hazard ratio: 0.55; 95% confidence interval: 0.34-0.88; p = 0.0131) and a significant reduction in all-cause mortality (5.396% per year vs. 7.489% per year; hazard ratio: 0.58; 95% confidence interval: 0.39-0.85; p = 0.0058). No significant differences were observed in the rates of acute myocardial infarction, cardiovascular death, heart failure hospitalization, or lower limb amputation.
CONCLUSIONS: Our findings indicate significantly lower risks of recurrent IS and all-cause mortality among patients with T2DM receiving SGLT2i treatment. Further studies are required to validate these results and investigate the underlying mechanisms behind the observed effects.
METHODS: Utilizing Taiwan\'s National Health Insurance Research Database, we identified 707 patients with T2DM treated with SGLT2i and 27 514 patients not treated with SGLT2i after an IS, respectively, from 1 May 2016 to 31 December 2019. Propensity score matching was applied to balance baseline characteristics. The follow-up period extended from the index date (3 months after the index acute IS) until the independent occurrence of the study outcomes, 6 months after discontinuation of the index drug, or the end of the study period (31 December 2020), whichever came first.
RESULTS: After propensity score matching, compared with the non-SGLT2i group (n = 2813), the SGLT2i group (n = 707) exhibited significantly lower recurrent IS rates (3.605% per year vs. 5.897% per year; hazard ratio: 0.55; 95% confidence interval: 0.34-0.88; p = 0.0131) and a significant reduction in all-cause mortality (5.396% per year vs. 7.489% per year; hazard ratio: 0.58; 95% confidence interval: 0.39-0.85; p = 0.0058). No significant differences were observed in the rates of acute myocardial infarction, cardiovascular death, heart failure hospitalization, or lower limb amputation.
CONCLUSIONS: Our findings indicate significantly lower risks of recurrent IS and all-cause mortality among patients with T2DM receiving SGLT2i treatment. Further studies are required to validate these results and investigate the underlying mechanisms behind the observed effects.
摘要：
目的：这项全国性队列研究评估了钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）对缺血性卒中（IS）后2型糖尿病（T2DM）患者的影响，旨在比较SGLT2i治疗的患者和未接受SGLT2i治疗的患者之间的临床结果。
方法：利用台湾国民健康保险研究数据库，我们确定了707例接受SGLT2i治疗的T2DM患者和27514例IS后未接受SGLT2i治疗的患者,分别,2016年5月1日至2019年12月31日。倾向评分匹配应用于平衡基线特征。随访期从指数日期（急性IS指数后3个月）延长至研究结果的独立发生。索引药物停药6个月后，或研究期结束（2020年12月31日），以先到者为准。
结果：在倾向得分匹配后，与非SGLT2i组(n=2813)相比，SGLT2i组(n=707)表现出显著较低的IS复发率(每年3.605%vs.每年5.897％；危害比：0.55；95％置信区间：0.34-0.88；p=0.0131），全因死亡率显着降低（每年5.396%与每年7.489%；风险比：0.58；95%置信区间：0.39-0.85；p=0.0058）。急性心肌梗死的发生率没有显著差异，心血管死亡,心力衰竭住院，或者下肢截肢.
结论：我们的研究结果表明，在接受SGLT2i治疗的T2DM患者中，复发性IS和全因死亡率的风险显著降低。需要进一步的研究来验证这些结果，并调查观察到的影响背后的潜在机制。
方法：利用台湾国民健康保险研究数据库，我们确定了707例接受SGLT2i治疗的T2DM患者和27514例IS后未接受SGLT2i治疗的患者,分别,2016年5月1日至2019年12月31日。倾向评分匹配应用于平衡基线特征。随访期从指数日期（急性IS指数后3个月）延长至研究结果的独立发生。索引药物停药6个月后，或研究期结束（2020年12月31日），以先到者为准。
结果：在倾向得分匹配后，与非SGLT2i组(n=2813)相比，SGLT2i组(n=707)表现出显著较低的IS复发率(每年3.605%vs.每年5.897％；危害比：0.55；95％置信区间：0.34-0.88；p=0.0131），全因死亡率显着降低（每年5.396%与每年7.489%；风险比：0.58；95%置信区间：0.39-0.85；p=0.0058）。急性心肌梗死的发生率没有显著差异，心血管死亡,心力衰竭住院，或者下肢截肢.
结论：我们的研究结果表明，在接受SGLT2i治疗的T2DM患者中，复发性IS和全因死亡率的风险显著降低。需要进一步的研究来验证这些结果，并调查观察到的影响背后的潜在机制。
