Metformin, SGLT2 Inhibitors Linked to Lower Dementia Risk

MONDAY, July 15, 2024 -- A recent review published online in the American Journal of Preventive Medicine has highlighted the comparatively lower risk of dementia associated with the use of metformin and sodium glucose co-transporter-2 inhibitors (SGLT2is) among antidiabetic medications. The study was led by Yongjun Sunwoo of Kyung Hee University's College of Pharmacy in Seoul, South Korea.

The research team conducted a comprehensive systematic review and meta-analysis, assessing data from 16 different studies that included a total of 1,565,245 patients. The primary aim was to evaluate the dementia and Alzheimer disease (AD) risks linked to various classes of antidiabetic medications.

The findings revealed that metformin and SGLT2is are associated with a significantly lower risk of both dementia and AD. Metformin, in particular, exhibited the lowest dementia risk among the broad range of antidiabetic drugs studied. Conversely, the highest dementia risk was associated with α-glucosidase inhibitors.

When focusing on second-line antidiabetic medications, SGLT2is showed the lowest risk for dementia. However, in elderly patients aged 75 years and older, the study noted a significantly higher risk of dementia with the use of dipeptidyl peptidase-4 inhibitors, metformin, sulfonylureas, and thiazolidinediones compared to SGLT2is.

Interestingly, the reduced dementia risk associated with metformin remained consistent regardless of the patients' diabetic complication status or baseline hemoglobin A1c levels.

The authors of the study emphasized the importance of optimal glycemic control through appropriate pharmacotherapy. They also pointed out the necessity of routine cognitive status monitoring in diabetic patients to improve outcomes related to diabetes mellitus-associated cognitive impairment.

The comprehensive analysis conducted by Sunwoo and colleagues sheds light on the crucial need for healthcare providers to strategically select antidiabetic medications to not only manage blood glucose levels but also potentially mitigate the risk of cognitive decline in diabetic patients.