Trends in Anti-Hyperglycemic Medicines Among US Adults With Diabetes and a History of Stroke.

backgroundDiabetes among adults with a history of stroke is associated with increased risks of recurrent vascular events and disability and greater healthcare costs. Contemporary glucose-lowering strategies now prioritize individualized therapy based on cardiovascular, renal, and metabolic factors over glycemic targets alone. However, national evidence on patterns of glucose-lowering medication use for this dual-diagnosis population is limited.

methodsWe analyzed serial cross-sectional MEPS data from 2017 to 2023 to characterize glucose-lowering medication use among US civilian, noninstitutionalized adults aged ≥ 18 years with self-reported diabetes and a history of stroke. Medication classes were defined via Multum codes and standardized names. Weighted prevalence with 95% CIs and linear trends were estimated. Medication use was compared between adults with and without a history of stroke using base models adjusted for sociodemographic factors and expanded models additionally adjusted for coronary disease history, annual recorded chronic kidney disease, heart failure, obesity, and approximate diabetes duration. Additional analyses used an alternative ICD-based case definition requiring E11 and I63 records within the same survey year.

resultsAmong 2241 person-years (representing 3.05 million annually), 82.4% used any glucose-lowering agent. Metformin (52.2%), insulin (35.6%), sulfonylureas (23.1%), GLP-1RAs (10.5%), DPP-4is (10.5%), and SGLT2is (9.4%) were most common. GLP-1RA/SGLT2i use rose from 8.7% to 33.8% (OR per year, 1.36; p < 0.001), whereas the downward trend in DPP-4i use was not statistically significant (OR per year, 0.91; 95% CI, 0.83-1.01; p = 0.074). In the base models, stroke history was associated with higher odds of insulin use (OR, 1.57) and lower odds of metformin use (OR, 0.78). After additional clinical adjustment, these associations were attenuated (ORs, 1.26 and 0.86, respectively), and neither met the exploratory multiplicity-adjusted threshold. The alternative ICD-based cohort included 125 person-years; trend estimates were imprecise, and some adjusted associations differed from those in the primary analysis.

conclusionsAdoption of newer agents increased markedly, yet most stroke survivors with diabetes still did not receive GLP-1RAs or SGLT2is by 2023. The metformin and insulin associations were attenuated after additional clinical adjustment, and neither met the exploratory multiplicity-adjusted significance threshold. Medication-use patterns among adults with diabetes and a history of stroke warrant further investigation using data that capture clinical characteristics and treatment timing.