Danish Study: GLP-1 Drugs Reduce Stroke Risk 31% vs DPP-4 Inhibitors in Type 2 Diabetes | Research

The takeaway

In 86,644 Danish T2D patients, GLP-1 RA new users had 31% lower stroke risk vs DPP-4i (aHRR 0.69), with both GLP-1 RA and SGLT2i showing lower mortality vs DPP-4i, but no MI difference.

31% less stroke
GLP-1 drug users had nearly one-third lower stroke risk than DPP-4 inhibitor users in nationwide Danish real-world data

What the researchers found

GLP-1 RA vs DPP-4i: stroke aHRR 0.69 (0.53-0.91). SGLT2i vs DPP-4i: stroke aHRR 0.80 (0.64-1.01, NS). Both GLP-1 RA and SGLT2i reduced mortality vs DPP-4i. No MI differences. GLP-1 vs SGLT2i: no significant differences.

Why it matters

Real-world confirmation of cardiovascular benefits helps solidify GLP-1 drugs and SGLT2 inhibitors as preferred over DPP-4 inhibitors for diabetic patients at cardiovascular risk.

How the study worked

Nationwide Danish cohort study (2014-2020), active comparator new-user design, 86,644 T2D patients (19,999 GLP-1 RA; 24,702 SGLT2i; 41,943 DPP-4i), adjusted for demographics, medications, and comorbidity, max 2-year follow-up.

What this study cannot tell us

2-year maximum follow-up. Observational despite adjustment. Cannot compare to non-drug-treated patients.

How to read the evidence

Nationwide population-based cohort with active comparator design. Strong real-world evidence confirming trial findings.

When this study was published

Published in 2025.

The bigger picture

Nationwide real-world data from Denmark's complete healthcare records provides definitive evidence supporting guideline preferences for GLP-1/SGLT2i over DPP-4i.

Questions still open

Should DPP-4 inhibitors be downgraded in T2D treatment algorithms?
Would longer follow-up reveal GLP-1 vs SGLT2i differences?
Are these findings consistent across Scandinavian and other populations?

Common questions

Which diabetes drug is best for preventing stroke?

In this Danish study, GLP-1 drugs had the lowest stroke risk — 31% lower than DPP-4 inhibitors. SGLT2 inhibitors also trended lower but didn't reach statistical significance.

Should I switch from a DPP-4 inhibitor?

If you have cardiovascular risk factors, this evidence supports switching to a GLP-1 drug or SGLT2 inhibitor. Discuss with your doctor about which would be best for your specific situation.

Read the original research

A Nationwide Danish Comparative Effectiveness Study of GLP-1 RA, SGLT2i and DPP-4i Treatment on Risk of Stroke, Myocardial Infarction and Mortality in Type 2 Diabetes.

Endocrinology, diabetes & metabolism, 9(1), e70165

View on PubMed ↗Publisher’s paper ↗

Citation

Hastrup, Sidsel; Hedegaard, Jakob N; Andersen, Grethe; Osler, Merete; Rungby, Jørgen; Johnsen, Søren Paaske. (2026). A Nationwide Danish Comparative Effectiveness Study of GLP-1 RA, SGLT2i and DPP-4i Treatment on Risk of Stroke, Myocardial Infarction and Mortality in Type 2 Diabetes.. Endocrinology, diabetes & metabolism, 9(1), e70165. https://doi.org/10.1002/edm2.70165