Many Stroke Survivors Develop Diabetes Within a Year, Highlighting the Need for GLP-1 Drug Trials | Research

The takeaway

Among 884 stroke patients, 12% transitioned from normal blood sugar to prediabetes or diabetes within one year, and nearly a quarter would qualify for semaglutide trials — yet almost no clinical trials exist for this population.

23.4% eligible for semaglutide trials
Nearly a quarter of ischemic stroke patients would qualify for GLP-1 receptor agonist trials, yet only one ongoing trial studies these drugs in the post-stroke setting

What the researchers found

At baseline, 44.6% of 884 ischemic stroke patients had normoglycemia, 33.9% had prediabetes, and 21.5% had type 2 diabetes. After 1 year, normoglycemia decreased by 12.1 percentage points while prediabetes increased by 10.2 points and diabetes by 1.9 points. Statin therapy was the only significant risk factor for glycemic progression.

23.4% (n=207) of the cohort would have met eligibility criteria for the SELECT trial on semaglutide in obese non-diabetics with prior cardiovascular disease. However, only one ongoing clinical trial is evaluating short-term cardiovascular risk reduction with these drugs in stroke patients specifically.

Why it matters

Stroke survivors face very high risk of recurrent cardiovascular events, and diabetes dramatically worsens that risk. GLP-1 receptor agonists like semaglutide have proven cardiovascular and metabolic benefits in other populations, yet they are barely being studied in stroke patients — a gap this study quantifies. Nearly a quarter of stroke patients could benefit from these peptide drugs but lack evidence to support their use.

How the study worked

Prospective observational cohort study using the STROKE-CARD Registry. 884 consecutive ischemic stroke patients were assessed for glycemic status (normoglycemia, prediabetes, type 2 diabetes) at baseline and at 1-year follow-up. Multivariate logistic regression identified factors associated with glycemic progression. Additionally, the authors reviewed ClinicalTrials.gov for ongoing GLP-1 RA and SGLT-2 inhibitor trials in acute ischemic stroke patients.

What this study cannot tell us

This is an observational study from a single registry, which may limit generalizability. The association between statin use and glycemic progression could be confounded by other factors. The review of clinical trials is a snapshot in time and may not capture all ongoing or planned studies. The study did not assess whether GLP-1 RA use would actually prevent glycemic progression in stroke patients.

How to read the evidence

This is a prospective observational cohort study from a structured stroke registry with 884 patients and 1-year follow-up. It provides strong epidemiological evidence of glycemic progression but does not test GLP-1 interventions directly.

When this study was published

Published in 2025, this study reflects the current gap in clinical trials for GLP-1 drugs in stroke survivors and provides timely data as these drugs gain broader cardiovascular indications.

The bigger picture

GLP-1 receptor agonists have demonstrated cardiovascular benefits in the SELECT and SUSTAIN trials, but stroke survivors — who are among the highest-risk cardiovascular patients — remain almost entirely unstudied. This paper highlights a critical clinical trial gap and makes the case for prioritizing GLP-1 drug research in the post-stroke setting.

Questions still open

Would early initiation of semaglutide or other GLP-1 drugs after stroke prevent the rapid glycemic deterioration observed in this cohort?
Why are statin-treated stroke patients more likely to develop diabetes, and could GLP-1 therapy offset this risk?
Could GLP-1 receptor agonists provide dual benefits in stroke survivors by reducing both cardiovascular recurrence and diabetes progression?

Common questions

Why do stroke patients develop diabetes so quickly?

Several factors contribute: stroke itself disrupts brain regions involved in metabolic regulation, post-stroke reduced physical activity promotes insulin resistance, and commonly prescribed medications like statins can worsen blood sugar. This study found that 12% of stroke patients with normal blood sugar at baseline developed prediabetes or diabetes within just one year, highlighting how quickly metabolic health can deteriorate after stroke.

Could GLP-1 drugs like semaglutide help stroke survivors?

Potentially, yes — GLP-1 drugs have proven benefits for blood sugar control, weight loss, and cardiovascular risk reduction in other populations. This study found that 23.4% of stroke patients would qualify for semaglutide trials, suggesting a large population that could benefit. However, almost no clinical trials have tested these drugs specifically in stroke survivors, which the authors identify as a critical gap that needs to be addressed.

Read the original research

Prediabetes and diabetes mellitus type II after ischemic stroke.

European stroke journal, 10(3), 822-828

View on PubMed ↗Publisher’s paper ↗

Citation

Moelgg, Kurt; Karisik, Anel; Scherer, Lukas; Buergi, Lucie; Dejakum, Benjamin; Komarek, Silvia; Granna, Julian; Boehme, Christian; Pechlaner, Raimund; Toell, Thomas; Knoflach, Michael; Kiechl, Stefan; Kaser, Susanne; Egger, Alexander; Griesmacher, Andrea; Mayer-Suess, Lukas. (2025). Prediabetes and diabetes mellitus type II after ischemic stroke.. European stroke journal, 10(3), 822-828. https://doi.org/10.1177/23969873241304301