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▎WuXi AppTec content team editor
The study included subjects
who used SGLT2 inhibitors or DPP-4 inhibitors in Ontario, Canada between July 1, 2016 ~ March 31, 2021.
The participants were ≥ 66 years
of age.
Use proven effective algorithms for Alzheimer's disease and related dementia to identify sporadic dementia
.
A propensity score-weighted Cox proportional hazard model was used to analyze the adjusted risk ratio (aHR) and 95% CI
for the onset of dementia.
Type 2 diabetes increases the risk of developing dementia, however, clinical guidance on dementia prevention strategies in people with type 2 diabetes is limited
.
Hypoglycemic drugs have been shown to reduce this risk to some extent, but not all categories are the same, including second-line therapies
that improve glycemic control.
Sodium-glucose co-transporter 2 inhibitors (SGLT2) are a new class of second-line oral hypoglycemic agents, but it remains to be determined
whether their use is associated with a lower risk of dementia.
A study by Professor Walter Swardfager and colleagues at the University of Toronto, Canada, published recently in Diabetes Care, aimed to determine whether the use of SGLT2 inhibitors versus dipeptidyl peptidase 4 (DPP-4) inhibitors was associated
with a reduced risk of dementia.
The results showed that the use of SGLT2 inhibitors was associated with a reduced risk of dementia in patients with
type 2 diabetes.
The study included subjects
who used SGLT2 inhibitors or DPP-4 inhibitors in Ontario, Canada between July 1, 2016 ~ March 31, 2021.
The participants were ≥ 66 years
of age.
Use proven effective algorithms for Alzheimer's disease and related dementia to identify sporadic dementia
.
A propensity score-weighted Cox proportional hazard model was used to analyze the adjusted risk ratio (aHR) and 95% CI
for the onset of dementia.
Of the 106903 participants, 36,513 were treated with SGLT2 inhibitors and 70,390 with DPP-4 inhibitors
.
From the start of treatment to a mean follow-up of 2.
80 years (SD 1.
07), a total of 2731 cases
of dementia were observed.
The use of SGLT2 inhibitors was associated with a lower risk of dementia compared with DPP-4 inhibitors (14.
2 per 1000 person-years; aHR 0.
80[95% CI 0.
71~0.
89]）
。
Compared with DPP-4 inhibitors, dapagliflozin showed the lowest risk of dementia among different SGLT2 inhibitors (aHR 0.
67 [95% CI 0.
53~0.
84]), followed by empagliflozin (aHR 0.
78 [95% CI 0.
69~0.
89]).
However, there was no correlation with canagliflozin (aHR 0.
96 [95% CI 0.
80~1.
16]).
In secondary analyses, a total of 1696 cases of dementia were observed from the initiation of treatment to a mean follow-up of 2.
09 years (SD 0.
96
).
Continued use of SGLT2 inhibitors without concomitant use of DPP-4 inhibitors was associated with a lower risk of dementia compared with continued use of DPP-4 inhibitors without concomitant SGLT2 inhibitors (aHR 0.
66 [95% CI 0.
57~0.
76]).
Overall, this large population-based cohort study showed a clinically significant association
between SGLT2 inhibitor use and a lower risk of dementia at an average follow-up of 2.
8 years.
The association varied between SGLT2 inhibitors, with dagliflozin and empagliflozin associated with a lower risk of dementia, while casagliflozin was not
.
Although a variety of methods have been used to qualify and minimize potential bias, the application of these methods does not exclude the possibility of residual confounding, so better designed randomised controlled trials are needed for further analysis
.
