Trends in the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists among ischemic stroke patients.

Ding Q, Sico JJ, Perkins AJ, Myers LJ, Daggy JK, Sexson A, Taylor SE, Burrone L, Waddell K, Bravata DM. Trends in the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists among ischemic stroke patients. Cardiovascular diabetology. Endocrinology reports. 2026 Mar 10; 12(1):DOI: 10.1186/s40842-026-00280-w.

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• IIR 16-211 – Addressing Sleep Apnea Post-Stroke (ASAP)

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Abstract:

BACKGROUND: Stroke is a leading cause of death and disability. Trials suggest that sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-receptor-1 receptor agonists (GLP-1 RAs) reduce cardiovascular risk in selected populations. OBJECTIVES: To describe facility-level use of SGLT-2i/GLP-1 RAs among patients hospitalized with ischemic stroke in the US Department of Veterans Affairs (VA) hospitals and to examine facility determinants of prescribing. METHODS: We performed a retrospective trend analysis across 88 VA facilities (fiscal years 2020–2023). Prescribing was ascertained from VA pharmacy data; the outcome was the proportion of ischemic-stroke admissions receiving an SGLT-2i or GLP-1 RA. Facility-level binomial logistic models evaluated associations with VA hospital complexity (1, high; 2, low complexity), rural-serving, and volume. RESULTS: Among 17,093 admissions, facility-level prescribing ranged from 13.2% to 38.3%. Overall use increased from 21.8% (2020) to 30.1% (2023; < i > P < /i > < 0.001), driven largely by patients with diabetes (38.9% to 51.5%); rates also increased in overweight patients (27.1% to 34.3%) but remained low in those without diabetes or overweight (3.4% to 7.0%, < i > P < /i > = 0.010). Across years, 45.7% of patients with diabetes received therapy versus 7.8% without diabetes. In adjusted analyses, prescribing rates were lower at complexity 1b (OR 0.8, 95% CI 0.66–0.96) and 1c (OR 0.69, 95%CI 0.58–0.83) versus 2; rural-serving and volume were not associated with prescribing. CONCLUSIONS: Use of SGLT-2i/GLP-1 RAs among patients with ischemic stroke increased modestly but remained low in those without diabetes. Substantial between-facility variation—particularly low prescribing rates at complexity class 1b/1c sites—highlights the need for future studies to evaluate barriers in prescribing. TRIAL REGISTRATION: ClinicalTrials.gov NCT04322162. Registration Date of 04/02/2020.