SUN-602 - SGLT2 Inhibitors Reduce the Risk of Recurrent Cerebral Infarction Compared to Metformin: A Real-World Retrospective Cohort Study

Introduction: Patients with type 2 diabetes are at increased risk of stroke, and prevention of recurrent cerebral infarction remains an important clinical challenge. Although SGLT2 inhibitors have demonstrated cardiovascular benefits, evidence on their association with recurrent cerebral infarction is still limited. This study therefore investigated whether SGLT2 inhibitor use was associated with a lower risk of recurrent cerebral infarction than metformin in a nationwide real-world cohort of patients with type 2 diabetes.

Methods: We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service database. Adults aged 19 years or older with type 2 diabetes who received SGLT2 inhibitors or metformin were identified. After applying the study eligibility criteria, patients were matched 1:4 by propensity score according to age, sex, index year, Charlson comorbidity index, and duration of antidiabetic drug use. The recurrence risk of cerebral infarction was evaluated using Cox proportional hazards regression analysis with adjustment for age, sex, severity, concurrent medication use, and comorbidities.

Results: A total of 6,600 patients were included after propensity score matching, including 1,322 SGLT2 inhibitor users and 5,278 metformin users. The mean age was 49.4 years, 58.2% were male, and the average follow-up duration was 663 days. Recurrent cerebral infarction occurred in 67 patients (5.1%) in the SGLT2 inhibitor group and 296 patients (5.6%) in the metformin group. In multivariable analysis, SGLT2 inhibitor use was associated with a significantly lower risk of recurrent cerebral infarction compared with metformin use (adjusted hazard ratio, 0.70; 95% confidence interval, 0.52–0.94; p=0.020).

Conclusion: SGLT2 inhibitors were associated with a lower risk of recurrent cerebral infarction compared with metformin in patients with type 2 diabetes, suggesting a potential role for SGLT2 inhibitors in the secondary prevention of cerebral infarction.

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