ABSTRACT NUMBER: ESOC2026A1453 FROM GLYCEMIC CONTROL TO VASCULAR PROTECTION: OPTIMIZING ANTI-DIABETIC THERAPY FOR STROKE RISK REDUCTION

Abstract Background and aims Diabetes substantially increase the risk of both first-ever and recurrent strokes. Although evidence suggests that glucose-lowering therapies differ in their cerebrovascular effects, treatment decisions in routine practice remain largely centered on glycemic control rather than stroke prevention. Understanding how clinicians and patients perceive, interpret, and operationalize this evidence is essential for optimizing anti-diabetic therapy to reduce stroke risk. Methods A qualitative study design was employed using semi-structured interviews with physicians, pharmacists, and patients involved in the management of diabetes. Interviews explored decision-making processes, perceived benefits and risks of anti-diabetic therapies, and contextual barriers to stroke-focused optimization. Data was analyzed using a framework analysis approach, allowing systematic identification of overarching themes and sub-themes. Analytical rigor was ensured through iterative coding, triangulation across stakeholder groups, and consensus validation. Results Four major themes emerged. (1) Clinical decision-making paradigms, encompassing sub-themes of risk–benefit trade-offs, adverse-effect vigilance, and alignment of therapy with comorbid cardiovascular profiles. (2) Health-system constraints, including formulary restrictions, medication cost, administrative burden, and limited continuity of follow-up. (3) Patient-related factors, such as medication adherence, injection aversion, weight expectations, and health literacy influencing shared decision-making. (4) Guideline-to-practice gaps, characterized by fragmented responsibility between specialties, limited stroke-specific performance indicators, and insufficient integration of cerebrovascular outcomes into diabetes care pathways. Participants emphasized the need for stroke-oriented prescribing frameworks, multidisciplinary care models integrating stroke specialists and pharmacists, targeted clinician education, and policy-level interventions to improve access to evidence-based therapies. Conclusions Optimizing anti-diabetic therapy for stroke prevention requires addressing clinical, systemic, and patient-level determinants through coordinated, cerebrovascular-focused implementation strategies. Conflict of interest Nothing to disclose