Researchers studying the cognitive effects of antidiabetic drugs in over 1.5 million patients with type 2 diabetes (T2DM) discovered that the risks of dementia and Alzheimer’s disease (AD) were notably lower in patients treated with metformin and sodium-glucose co-transporter-2 inhibitors (SGLT-2i) compared to other antidiabetic medications.
The study, featured in the American Journal of Preventive Medicine by Elsevier, sheds light on the potential cognitive benefits of specific antidiabetic treatments for individuals with T2DM.
T2DM has emerged as a significant global health concern affecting approximately 530 million individuals worldwide. Research suggests a 50% or higher increased risk of cognitive issues and dementia among T2DM patients, leading to challenges in memory, attention, and executive function. Dementia affects more than 40 million individuals globally, making it a pressing health issue.
Lead investigator Dr. Yeo Jin Choi from Kyung Hee University in Seoul, Korea, underscores the rising prevalence of diabetes and dementia and emphasizes the urgent need for comprehensive research on dementia risks linked to antidiabetic treatments. Understanding the cognitive impacts of antidiabetic medications is not only essential for optimizing patient care but also for guiding regulatory decisions and clinical guidelines to enhance patient safety and public health.
The research team examined various databases to identify observational studies exploring the incidence of dementia and AD in patients after starting antidiabetic treatments. The analysis included data from 16 studies encompassing 1,565,245 participants. By utilizing Bayesian network meta-analysis, they evaluated the dementia and AD risks associated with different antidiabetic drug classes, including DPP4 inhibitors, metformin, SGLT-2 inhibitors, sulfonylureas, alpha-glucosidase inhibitors, and thiazolidinediones.
Previous studies had hinted at an increased dementia risk from certain antidiabetic drugs, particularly those with high hypoglycemic potential like sulfonylureas and alpha-glucosidase inhibitors. However, the evidence regarding dementia risks with SGLT-2 inhibitors was limited before this investigation.
The study revealed that patients on metformin had the lowest risk of dementia and AD. Additionally, SGLT-2 inhibitors, which include Farxiga® and Jardiance®, were linked to reduced dementia and AD risks, alongside cardiovascular health benefits.
For patients under 75 years old, the dementia risk associated with SGLT-2 inhibitors was comparable to other antidiabetic medicines. Conversely, individuals aged 75 or older had notably higher dementia risks with DPP4 inhibitors, metformin, sulfonylureas, and thiazolidinediones compared to SGLT-2 inhibitors. Women also exhibited significantly lower dementia risks with SGLT-2 inhibitors versus sulfonylureas.
The researchers acknowledged that they did not evaluate the dementia and AD risks of other antidiabetic drugs like GLP-1 agonists and insulin in this study.
This study contributes to expanding our knowledge of diabetes management by underscoring the importance of considering both metabolic and cognitive health outcomes in clinical settings. It underscores the necessity of tailored treatment strategies for diabetes, considering individual factors such as age, sex, complications, BMI, A1C levels, and cognitive health status when making treatment decisions for diabetic patients.
Dr. Yeo Jin Choi expressed surprise at the study’s findings, particularly the potential cognitive advantages of SGLT-2 inhibitors in individuals aged 75 and above compared to metformin and DPP-4 inhibitors. This discovery is noteworthy, especially since SGLT-2 inhibitors are currently used in managing heart failure. The study’s implications suggest additional benefits of SGLT-2 inhibitors in reducing dementia risk, offering significant insights for diabetes management. Older patients aged 75 and above could particularly benefit from these findings due to their heightened cognitive health concerns.
