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Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities – published online 16/04/2024

Sacco graphical abstract

Simona Sacco, Matteo Foschi, Raffaele Ornello, Federico De Santis, Riccardo Pofi, Michele Romoli

The intertwining of diabetes mellitus and stroke extends from pathogenic mechanisms to the need for tailored care. Diabetes and hyperglycaemia worsen stroke outcomes, with hyperglycaemia in the acute ischaemic stroke phase increasing the risk of haemorrhagic transformation and poor functional recovery, emphasising the need for early severe hyperglycaemia management. Intensive glucose control within a comprehensive care bundle improves outcomes post haemorrhagic stroke. Considering the frequent micro- and macrovascular complications seen in diabetes, tailored cardiovascular prevention strategies are essential. Sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists allow tailored treatment strategies, which are particularly beneficial for individuals with heart failure and chronic kidney disease. In this issue, Sacco, et al (https://doi.org/10.1007/s00125-024-06146-z) synthesise hyperacute stroke management and cardiovascular prevention concepts in people with diabetes, informing clinicians on preferred treatments based on large studies and RCTs. The figures from this review are available as a downloadable slideset.

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