Effect of Antidiabetic Drugs on the Outcomes of Remote Ischemic Conditioning in Patients with Diabetes Mellitus Complicated by Acute Ischemic Stroke: A Post-Hoc Analysis of the RICAMIS Trial

doi:10.3969/j.issn.1673-5765.2026.07.003

Abstract

Abstract: Objective To investigate the effect of different antidiabetic drug regimens on the efficacy of remote ischemic conditioning (RIC) in the treatment of acute ischemic stroke.
Methods Based on the remote ischemic conditioning for acute moderate ischemic stroke (RICAMIS) cohort, this study included patients with pre-existing or newly diagnosed diabetes and documented antidiabetic drug use. They were divided into three groups according to antidiabetic drug regimen: the insulin group, the oral hypoglycemic medication group, and the combined therapy group (insulin plus oral hypoglycemic medication). The primary outcome was excellen functional outcome at 90 days (mRS score 0-1). Secondary outcomes included favorable functional outcome at 90 days (mRS score 0-2), early neurological deterioration (defined as an increase of ≥2 points in NIHSS score from baseline within 7 days of onset), change in NIHSS score at 12 days, and stroke-associated pneumonia within 12 days. The effects of RIC versus conventional medical therapy on these outcomes were compared within each group, and the interaction between different antidiabetic drug regimens and RIC efficacy was evaluated.
Results A total of 378 patients were included in this study, including 131 in the insulin group (64 receiving RIC and 67 receiving conventional medical therapy), 186 in the oral hypoglycemic medication group (88 receiving RIC and 98 receiving conventional medical therapy), and 61 in the combined therapy group (32 receiving RIC and 29 receiving conventional medical therapy). There were no statistically significant differences in the proportions of excellent or favorable functional outcomes between RIC and conventional medical therapy within each of the three groups. In the insulin group, the incidence of early neurological deterioration was significantly higher with RIC than with conventional medical therapy (14.1% vs. 3.0%, OR 5.32, 95% CI 1.10-25.66, P=0.04). Similarly, in the oral hypoglycemic medication group, RIC was associated with a significantly increased risk of early neurological deterioration (22.7% vs. 11.2%, adjusted OR 2.33, 95%CI 1.03-5.29, P=0.04). In the combined therapy group, no significant difference was observed between RIC and conventional medical therapy (adjusted P=0.48). No significant differences were found in changes in NIHSS score at 12 days or the incidence of stroke-associated pneumonia within 12 days between RIC and conventional medical therapy across the three groups. Interaction analysis showed no interaction between antidiabetic drug regimens and treatment assignment for any of the aforementioned outcomes (all P values for interaction > 0.05).
Conclusions In patients with diabetes complicated by acute ischemic stroke, RIC did not improve 90-day functional outcomes compared with conventional medical therapy across different antidiabetic drug regimens. RIC increased the risk of early neurological deterioration in patients treated with either insulin or oral hypoglycemic agents.

Key words: Acute ischemic stroke; Remote ischemic conditioning; Antidiabetic drug; Early neurological deterioration

摘要： 目的探讨不同降糖药物方案对远隔缺血适应（remote ischemic conditioning，RIC）治疗急性缺血性卒中疗效的影响。
方法基于RIC治疗急性中度缺血性卒中的有效性和安全性（remote ischemic conditioning for acute moderate ischemic stroke，RICAMIS）研究队列，纳入有明确糖尿病病史或新诊断糖尿病且有用药情况记录的患者，按降糖药物方案将其分为胰岛素组、口服降糖药组及联合用药（胰岛素+口服降糖药）组。主要结局指标为90 d极好功能结局（mRS评分0～1分）；次要结局指标包括90 d良好功能结局（mRS评分0～2分）、早期神经功能恶化（发病7 d内NIHSS评分较入院时升高≥2分）、12 d NIHSS评分变化及12 d卒中相关肺炎。比较各组中RIC治疗与常规内科治疗对上述结局指标的影响，并评估不同降糖药物方案与RIC疗效的交互作用。
结果本研究共纳入378例患者，其中胰岛素组131例（RIC治疗64例、常规内科治疗67例）、口服降糖药组186例（RIC治疗88例、常规内科治疗98例）、联合用药组61例（RIC治疗32例、常规内科治疗29例）。3组中接受RIC治疗与常规内科治疗患者的极好及良好功能结局比例差异均无统计学意义。胰岛素组中，RIC治疗患者的早期神经功能恶化发生率高于常规内科治疗患者（14.1% vs. 3.0%，OR 5.32，95%CI 1.10～25.66，P=0.04）；口服降糖药组中亦观察到RIC治疗可升高早期神经功能恶化风险（22.7% vs. 11.2%，校正OR 2.33，95%CI 1.03～5.29，P=0.04）；联合用药组中接受RIC治疗与常规内科治疗的差异无统计学意义（校正P=0.48）。3组中RIC治疗12 d NIHSS评分变化及12 d卒中相关肺炎发生率与常规内科治疗相比，差异均无统计学意义。交互作用分析显示，降糖药物方案与治疗方法对上述各项结局指标的影响均无交互作用（P交互>0.05）。
结论在糖尿病合并急性缺血性卒中患者中，不同降糖药物方案下，RIC治疗较常规内科治疗均未能改善患者的90 d功能结局，且对于胰岛素治疗和口服降糖药物的患者，RIC治疗均增加了早期神经功能恶化的风险。

关键词: 急性缺血性卒中; 远隔缺血适应; 降糖药物; 早期神经功能恶化

CLC Number:

LI Ying, CUI Yu, LONG Yuxia, GUO Xuanyu, CHEN Huisheng. Effect of Antidiabetic Drugs on the Outcomes of Remote Ischemic Conditioning in Patients with Diabetes Mellitus Complicated by Acute Ischemic Stroke: A Post-Hoc Analysis of the RICAMIS Trial[J]. Chinese Journal of Stroke, 2026, 21(7): 805-813.

李莹, 崔钰, 陇玉霞, 郭暄宇, 陈会生. 降糖药物对远隔缺血适应治疗糖尿病合并急性缺血性卒中患者的疗效影响：RICAMIS研究事后分析[J]. 中国卒中杂志, 2026, 21(7): 805-813.

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URL: https://www.chinastroke.org.cn/EN/10.3969/j.issn.1673-5765.2026.07.003

https://www.chinastroke.org.cn/EN/Y2026/V21/I7/805

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