Guangzhou, China — A new clinical trial offers novel evidence for reducing stroke recurrence in patients with type 2 diabetes who have experienced a mild ischemic stroke or high-risk transient ischemic attack (TIA). The study found that adding the glucagon-like peptide 1 receptor agonist (GLP 1 RA) liraglutide to standard secondary prevention significantly lowered the 90 day risk of recurrent stroke and improved neurological functional outcomes.

The findings of the multicenter, randomized controlled trial, named LAMP, were published online as an original article in JAMA Internal Medicine on November 4, 2025. The research was led by Professor Xu Anding and Professor Zhu Huili from the Department of Neurology at the First Affiliated Hospital of Jinan University.

Addressing High Recurrence Risk

Patients with minor ischemic stroke or high-risk TIA face a substantially elevated risk of early recurrence, which severely impacts quality of life. Those with type 2 diabetes have a recurrence risk 2–3 times higher than the general population. Although current standard secondary prevention strategies are widely used, a significant residual recurrence risk remains, calling for additional therapeutic approaches.

While GLP 1 RAs have been shown to reduce major cardiovascular events in high-risk type 2 diabetes patients, their efficacy and safety for preventing recurrence in the acute phase of stroke had not been established.

Study Design and Key Outcomes

The LAMP trial was a multicenter, prospective, randomized, open-label, blinded-endpoint (PROBE) study. It evaluated the efficacy and safety of liraglutide initiated within 24 hours of onset in patients with type 2 diabetes who presented with mild acute ischemic stroke or high-risk TIA.

A total of 636 patients from 27 centers across China were randomized to receive either standard secondary prevention plus liraglutide (medication group) or standard prevention alone (control group).

Results demonstrated that compared with the control group, the liraglutide group had a significantly lower 90 day stroke recurrence rate (7.9% vs. 13.8%). The composite endpoint of new vascular events (ischemic/hemorrhagic stroke, TIA, myocardial infarction, or vascular death) within 90 days was also markedly reduced in the medication group (8.5% vs. 15.7%). Regarding functional recovery, a higher proportion of patients in the liraglutide group achieved a favorable neurological outcome (modified Rankin Scale score 0–1) at 90 days (87.3% vs. 77.8%). Safety profiles were comparable between groups, with no increase in adverse events other than the known gastrointestinal side effects associated with GLP 1 RAs.

Why Liraglutide? Focusing on Acute-Phase Safety

The choice of liraglutide among various GLP 1 RAs was primarily driven by acute-phase safety considerations. As a once-daily injection with a relatively short half-life, liraglutide allows for quicker dose adjustment or discontinuation if intolerance occurs—particularly relevant for gastrointestinal side effects such as vomiting, which could raise aspiration risk in stroke patients. This feature may offer greater flexibility and safety in the acute stroke setting compared with longer-acting weekly formulations.

Implications and Future Directions

The LAMP trial provides first-level evidence that early adjunctive therapy with liraglutide, on top of standard care, can further lower stroke recurrence risk and enhance functional recovery in patients with type 2 diabetes experiencing a minor stroke or high-risk TIA. These findings introduce a new evidence-based strategy to address the residual recurrence risk in this high-risk population.

The study's first author is Dr. Zhu Huili, Chief Physician of the Department of Neurology at the First Affiliated Hospital of Jinan University. The corresponding authors are Professor Xu Anding and Professor Wang Yongjun from Beijing Tiantan Hospital, Capital Medical University. Professor Xiangbing Wang of Rutgers University served as an academic committee member and co-author. The research was supported by grants from the Guangzhou Science and Technology Program.

(Image provided by the contributing unit)