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A letter to the editor is presented in response to the article "GLP-1 Response to Oral Glucose Is Reduced in Prediabetes, Screen-Detected Type 2 Diabetes and Obesity and Influenced by Sex: The ADDITION-PRO Study" published in the journal in 2015.

Diabetes mellitus (DM) has long been established as an independent risk factor for acute stroke. However, data on the potential impact of oral antidiabetic medication in use prior to stroke on the clinical severity of patients upon admission is scarce and derives from heterogeneous populations. A protective effect for the ATP-sensitive potassium channels has been suggested in cerebral hypoxia through their role in modulating ischemic preconditioning. Blockade of sulfonylurea (SUR)1 receptor with SUR compounds in animal models of acute stroke was recently shown to exert neuroprotective effects, by reducing cerebral edema, infarct volume (mostly cortical sparing) and overall mortality by 50%. We retrospectively examined records from 570 patients with type 2 DM who suffered a first-ever acute stroke and were enrolled in our Acute Stroke Unit databank; of those, 320 (56%) were receiving oral antidiabetic drugs, whereas 250 (44%) either insulin regimens or diet alone. Most of those on oral antidiabetic drugs (Group A; N=185, 58%) were on SUR agents (alone or in combination), whereas the others (Group B; N=135, 42%) were receiving non-SUR drugs. We used the Scandinavian Stroke Scale (SSS) to evaluate neurological impairment on admission, as it provides the most robust and reliable composite assessment of early neurological deficit. Group A patients presented with a significantly higher SSS score compared to subjects in Group B (35.1±1.4 vs. 30.1±1.7; p=0.016). Prior SUR use was the only independent predictor of neurological severity by linear regression analysis. Patients did not differ in age, gender distribution, BMI, smoking or alcohol consumption habits between groups. Other risk factors (blood pressure, lipoproteins, acute phase proteins, fibrinogen) were also not statistically different between groups. Interestingly, Group A subjects were less prone to MRI-detected lacunar infracts compared to Group B (19.6% vs. 25.6%, p<0.001). Hemorrhagic stroke comprised almost 8% of the cases in both groups. Our findings indicate an association between prior use of SUR drugs and less severe immediate neurological deficit in this highly homogeneous population of patients with type 2 DM. Further studies should aim at delineating the impact of SUR use on long term survival and recovery from stroke; targeting SUR 1 receptors may provide a new therapeutic approach to stroke. [ABSTRACT FROM AUTHOR]