A study published in ‘The British Medical General’ suggests that sodium-glucose cotransporter-2 (SGLT-2) inhibitors, commonly used to treat type 2 diabetes, may help prevent dementia, with greater benefits observed with prolonged treatment.
The study, conducted in Korea, cautions that the effect size may have been exaggerated in this observational analysis. The researchers now recommend randomized controlled trials to confirm these results.
According to the World Health Organization, the number of people with dementia worldwide is expected to reach 78 million by 2030. Type 2 diabetes is associated with a higher risk of developing dementia.
A recent study involving people over 65 with type 2 diabetes indicated a decreased risk of dementia associated with SGLT-2 inhibitors compared to dipeptidyl peptidase-4 (DPP-4) inhibitors, another type of diabetes drug. However, the effects on younger individuals and specific types of dementia (e.g., Alzheimer’s disease, vascular dementia) remain unclear.
To explore this further, researchers used data from the Korea National Health Insurance Service to identify 110,885 pairs of adults aged 40-69 years with type 2 diabetes who were free of dementia and began treatment with either an SGLT-2 inhibitor or a DPP-4 inhibitor between 2013 and 2021.
All participants (average age 62; 56% men) were matched by age, sex, use of the diabetes drug metformin, and baseline cardiovascular risk. They were followed for an average of 670 days to monitor the development of dementia.
Potentially influential factors, including personal characteristics, income level, underlying risk factors for dementia, other conditions, and related medication use, were also considered.
During the follow-up period, 1,172 participants were newly diagnosed with dementia.
Dementia rates per 100 person-years were 0.22 for those using SGLT-2 inhibitors and 0.35 for those using DPP-4 inhibitors, corresponding to a 35% reduced risk of dementia associated with SGLT-2 inhibitors compared to DPP-4 inhibitors.
The researchers also found a 39% reduced risk of Alzheimer’s disease and a 52% reduced risk of vascular dementia associated with SGLT-2 inhibitors compared to DPP-4 inhibitors.
Moreover, the effect of SGLT-2 inhibitors appeared more pronounced with longer treatment duration. A 48% reduced risk of dementia was observed for more than two years of treatment, compared to a 43% reduced risk for two years or less.
As this is an observational study, no firm conclusions can be drawn about cause and effect. The authors note that details of health behaviors (e.g., smoking and alcohol consumption) and duration of type 2 diabetes were not fully available.
However, they emphasize that this was a large study based on nationally representative data, which included relatively younger people with type 2 diabetes, and the results were highly consistent across subgroups.
Consequently, the researchers suggest that SGLT-2 inhibitors might help prevent dementia, with greater benefits seen with longer treatment, and they call for randomized controlled trials to confirm these findings.
In a linked editorial, researchers from Taiwan describe these results as promising with important implications for clinical practice and public health. They agree that further trials are needed to confirm these findings and suggest that studies should also explore the underlying mechanisms of any neuroprotective effects of SGLT-2 inhibitors.
As there is currently no cure for dementia and few effective treatment options, strategies that could potentially prevent its onset are critically important, they write.
Given the significant socioeconomic and public health burdens associated with both dementia and type 2 diabetes, the editorial authors recommend that clinical guidelines and healthcare policies be regularly updated to incorporate the latest evidence on the potential benefits of SGLT-2 inhibitors, including their potential to reduce dementia risk.
(ANI)
