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Sulphonylurea Drugs Can Have Neuroprotective Effects in Diabetic Patients
Posted: Wednesday, March 04, 2009
Hospitalized diabetic stroke patients who receive sulphonylurea therapy appear to be less likely to die and more likely to have a better outcome than patients who do not receive this type of therapy, according to data analyzed from a large patient population that was diagnosed with ischemic stroke.
The study was presented February 18 at the International Stroke Conference (ISC) 2009 in a poster by Frank L. Silver, Toronto Western Research Institute, University Health Network's Stroke Program, University of Toronto, Toronto, Ontario, and colleagues.
"While the data is observational, the results were very significant," said Dr. Silver. "Patients treated with sulphonylureas did considerably better in areas of reduced edema, infarct, and mortality."
The researchers used data from phase 3 of the Registry of the Canadian Stroke Network (RCSN) between July 1, 2003, and March 31, 2008, on stroke patients who presented to 1 of 11 stroke centers in Ontario within 24 hours of stroke onset and had a medical history that included diabetes.
The study looked at stroke risk factors, stroke severity, comorbidity, and outcomes among patients who were on a sulphonylurea prior to and then during their hospital stay and were then compared with the risk factors of patients who did not receive sulphonylureas.
Over the observation period, 12,456 patients were admitted with a definitive diagnosis of ischemic stroke. A total of 9,801 patients arrived within 24 hours of stroke onset and, of these, 2,448 were diabetic. Tissue plasminogen activator (tPA) therapy was administered to 13.4% of the patients.
Patients with diabetic stroke were evaluated according to therapy: 1,469 did not receive sulphonylureas (group 1); 134 received sulphonylurea therapy in hospital (group 2); 116 had been on sulphonylureas, but the drug was stopped after admission (group 3); 729 received sulphonylurea therapy before and after hospitalization (group 4). Mean age was 72.5 years and 43% were female.
Dr. Silver said that sulphonylurea dosages were not considered in the final analysis. "The patient was either on the drug or they were not," he said.
Results showed that group 1 had lower median admission glucose levels than group 4 (8.6% vs 10.4%, P < .0001), were more likely to be on insulin therapy than group 4 (29% vs 5.4%, P < .0001), and had slightly more severe strokes, although this was a not a significant different.
Group 3 had considerably worse outcomes than the other groups, with an odds ratio for death of 2.4 (95% confidence interval [CI], 1.5-3.9). Among patients who were treated with tPA, sulphonylurea therapy resulted in a similar reduction in death, with an odds ratio of 0.3 (95% CI, 0.12-0.73).
Dr. Silver emphasized that there were limitations to his study and that his next study will use different statistical methods that break down the comparisons on a more individual basis, to make sure there is no bias among the groups.
"We looked at a great number of patients and this study suggests that patients treated with sulphonylureas did significantly better," he concluded.
Source: Diabetes In Control: Presentation title: Possible Neuroprotective Effects of Sulfonylureas in Diabetic Patients With Acute Ischemic Stroke. Abstract P19
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