Metformin, Other Antidiabetic Drugs Reduce the Risk of Dementia in Patients With T2D

Among patients with type 2 diabetes mellitus (T2DM), the risk of dementia and Alzheimer disease (AD) is significantly lower in those treated with metformin and sodium-glucose cotransporter 2 (SGLT2) inhibitors compared with other antidiabetic drugs. The results were published in the American Journal of Preventative Medicine.

“As the prevalence of both diabetes and dementia continues to rise each year, and with mounting evidence suggesting a strong correlation between diabetes and dementia, the need for comprehensive research in dementia risk associated with antidiabetic treatment becomes increasingly imperative,” said lead investigator Yeo Jin Choi, PharmD, PhD, of the Department of Pharmacy, College of Pharmacy; Department of Regulatory Science, Graduate School; and Institute of Regulatory Innovation Through Science, Kyung Hee University, via a press release. “Understanding the potential cognitive effects of antidiabetic medications is not only crucial for optimizing patient care but also for informing regulatory decisions and clinical practice guidelines to prioritize patient safety and promote public health,”

Researchers performed a search of the Cochrane Central Register of Controlled Trials, Embase, MEDLINE (PubMed), and Scopus databases from inception to March 2024 to identify observational studies investigating incidence of dementia and AD in patients after initiation of antidiabetic drugs. The analysis comprised 1,565,245 patients from 16 studies.

The results showed that the lowest risk of dementia and AD was found in patients on metformin. Moreover, SGLT2 inhibitors, which include Farxiga and Jardiance, were associated with a lower risk of dementia and AD, as well as cardiovascular health benefits. Notably, the study found that dementia risk was significantly lower with SGLT2 inhibitors compared with sulfonylureas in women.

“We were quite surprised by the study results, particularly the potential cognitive benefits of SGLT2 inhibitors over metformin and DPP-4 inhibitors in patients aged 75 years or older. This finding is particularly notable given that SGLT2 inhibitors are currently used for heart failure management as well,” Dr. Yeo Jin Choi said. “Our study contributes to the existing evidence by suggesting potential additional benefits of SGLT2 inhibitors in mitigating dementia risk, thereby providing significant clinical implications for diabetes management.”