Stroke represents a major burden in patients with type 2 diabetes, yet this cerebrovascular complication has been less carefully investigated than the risk of cardiovascular mortality, heart failure and renal disease. Some data suggested that glucagon-like peptide-1 receptor agonists (GLP-1RAs) exert a better protection against stroke than sodium-glucose cotransporter 2 inhibitors (SGLT2is). However, this conclusion was derived from indirect comparisons in absence of any head-to-head randomised controlled trial (RCT). The present comprehensive review compares the effects of SGLT2is versus GLP-1RAs on nonfatal and fatal/nonfatal strokes in network meta-analyses of RCTs (mostly cardiovascular outcome trials) versus placebo, on the one hand, and in real-life observational cohort studies, on the other hand. Whereas network meta-analyses of placebo-controlled RCTs confirm a slight but significant (in 11 out of 13 meta-analyses) higher incidence of stroke in patients treated with SGLT2is compared with those treated with GLP-1RAs, a large majority of retrospective observational cohort studies (19 out of 21) failed to find any significant difference in the risk of stroke between the two pharmacological classes. Available, yet limited, findings suggest that SGLT2is may be more efficacious against haemorrhagic than ischaemic strokes, in patients at risk for atrial fibrillation and in patients with chronic kidney disease.

中风是 2 型糖尿病患者的主要负担，但与心血管死亡、心力衰竭和肾脏疾病风险相比，这种脑血管并发症的研究较少。一些数据表明，胰高血糖素样肽 1 受体激动剂 (GLP-1RA) 比钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2is) 能更好地预防中风。然而，这一结论是在没有任何头对头随机对照试验（RCT）的情况下通过间接比较得出的。本综合综述一方面在随机对照试验（主要是心血管结果试验）与安慰剂的网络荟萃分析中比较了 SGLT2is 与 GLP-1RA 对非致命性和致命性/非致命性中风的影响，另一方面在现实生活中的观察性队列研究中，另一方面。尽管安慰剂对照随机对照试验的网络荟萃分析证实，与接受 GLP-1RA 治疗的患者相比，接受 SGLT2 治疗的患者中风发生率略有升高（13 项荟萃分析中的 11 次），但绝大多数回顾性观察队列研究（21 项中的 19 项）未能发现两种药理学类别之间的中风风险存在任何显着差异。现有但有限的研究结果表明，对于有房颤风险的患者和慢性肾病患者，SGLT2is 可能比缺血性中风更有效地治疗出血性中风。