Summary: GLP-1 agonists like Ozempic reduce the risk of dementia in type 2 diabetes patients. The research followed over 88,000 individuals for up to ten years, showing a 30% lower risk compared to sulfonylureas and a 23% lower risk compared to DPP-4 inhibitors.
These findings can guide doctors in selecting medications for older diabetes patients. However, further randomized trials are needed to confirm these results.
Key Facts:
- Significant Risk Reduction: GLP-1 agonists reduce dementia risk by 30% compared to sulfonylureas.
- Study Scope: Followed over 88,000 older adults with type 2 diabetes for up to ten years.
- Clinical Implications: Findings can help doctors make informed medication choices for diabetes patients.
Source: Karolinska Institute
People with type 2 diabetes who are treated with GLP-1 agonists have a decreased risk of developing dementia, according to a new study from Karolinska Institutet published in the journal eClinicalMedicine.
Drugs known as GLP-1 agonists or GLP-1 analogs have become increasingly popular in treating type 2 diabetes and obesity as they help control blood sugar, promote weight loss and protect the heart.
People with type 2 diabetes have an increased risk of developing dementia and it’s been hypothesized that newer diabetes drugs such as GLP-1 agonists and DPP-4 inhibitors might have a protective effect.
In the new register-based study, researchers followed more than 88,000 older individuals with type 2 diabetes for up to ten years. Using a study design called target trial emulation, which imitates a randomized clinical trial, they analyzed the association between three diabetes drugs (GLP-1 agonists, DPP-4 inhibitors or sulfonylureas) and the risk of dementia.
Can help doctors make better decisions
They found that patients who used GLP-1 agonists had a 30% lower risk of developing dementia compared to those who used sulfonylureas, and a 23% lower risk compared to those who used DPP-4 inhibitors.
“This is important because it can help doctors make better decisions about which medicines to use for older patients with type 2 diabetes,” says Bowen Tang, a Ph.D. student in Sara Hägg’s research group at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
“However, proper randomized trials are needed to establish with certainty that GLP-1 agonists reduce the risk of dementia.”
About this neuropharmacology and Alzheimer’s disease research news
Author: Bowen Tang
Source: Karolinska Institute
Contact: Bowen Tang – Karolinska Institute
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Comparative effectiveness of glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, and sulfonylureas on the risk of dementia in older individuals with type 2 diabetes in Sweden: an emulated trial study” by Bowen Tang et al. eClinicalMedicine
Abstract
Comparative effectiveness of glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, and sulfonylureas on the risk of dementia in older individuals with type 2 diabetes in Sweden: an emulated trial study
Background
The comparative effectiveness of glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sulfonylureas on the risk of dementia in older individuals with type 2 diabetes mellitus (T2DM) is unknown.
Methods
We conducted a sequential trial emulation from 1st January 2010 to 30th June 2020 using data from Swedish national registers. Swedish residents who were aged 65 or older, had type 2 diabetes (T2DM), and initiated GLP-1 agonists, DPP-4 inhibitors, or sulfonylureas were followed for up to 10 years to assess the risk of dementia. Participants who had dementia, used the three drug classes, or had contraindications were excluded from enrollment.
The characteristics between arms were balanced through the application of propensity scores estimated from predefined covariates. Intention-to-treat effects were analysed with all enrolled participants, while the per-protocol effects were analysed with participants who adhered to the assigned treatment.
Findings
The pooled trial included 88,381 participants who received prescriptions for GLP-1 agonists (n = 12,351), DPP-4 inhibitors (n = 43,850), or sulfonylureas (n = 32,216) at baseline and were followed for an average of 4.3 years. A total of 4607 dementia cases developed during follow-up: 278 for the GLP-1 agonist initiators (incidence rate: 6.7 per 1000 person years), 1849 for DPP-4 inhibitor initiators (IR: 11.8), and 2480 for sulfonylurea initiators (IR: 13.7).
In an intention-to-treat analysis, GLP-1 agonist initiation was associated with a reduced risk of dementia compared to sulfonylureas (hazard ratio: 0.69, 95% CI: 0.60–0.79, p < 0.0001) and DPP-4 inhibitors (HR: 0.77, 95% CI: 0.68–0.88, p < 0.0001), after adjusting for age, enrollment year, sex, socioeconomic factors, health conditions, and past medication uses.
These findings were consistent in several sensitivity analyses, including a per-protocol analysis (HR for sulfonylureas: 0.41, 95% CI: 0.32–0.53, p < 0.0001; HR for DPP-4 inhibitors: 0.38, 95% CI: 0.30–0.49, p < 0.0001).
Interpretation
Our research suggested that GLP-1 agonists were associated with a lower risk of dementia compared to sulfonylureas and DPP-4 inhibitors in older individuals with T2DM. Further clinical trials are needed to validate these findings.
Funding
Swedish Research Council, Karolinska Institutet, the National Institute on Aging, the National Institutes of Health, and Riksbankens Jubileumsfond.
