People who took an older class of diabetes medication known as glitazones had a 22% lower risk of developing dementia, says BMJ Open Diabetes Research & Care following an observational study that suggests the inexpensive medicines could be researched to help combat cognitive decline.
The findings, reports Bloomberg, suggest more research could be done on glitazones for dementia. The most common type of dementia, Alzheimer’s disease, is a huge target for pharma companies looking to develop therapies.
“Repurposing an existing drug used for another health condition would be a cheaper and quicker way to bring about a new dementia treatment,” said James Connell, head of translational science at Alzheimer’s Research UK. But first there needed to be rigorous clinical trials to see if glitazones could truly help, said Connell, who wasn’t affiliated with the study.
The researchers, led by Jin Zhou of the University of Arizona, drew on electronic health records of almost 600 000 people from the US National Veteran Affairs Health System diagnosed with diabetes in recent decades.
The scientists compared the dementia risk in older people who had been treated with either a glitazone or a type of diabetes drug called sulfonylurea with those who had only received metformin, the first drug generally prescribed to control blood sugar.
Most patients were male, white and more than half were considered obese. They suffered from type 2 diabetes, which is more common in older adults.
Taking glitazones – whose brand names include Actos – was associated with an 11% lower risk of Alzheimer’s disease and 57% lower risk of vascular dementia compared with just taking metformin.
Type 2 diabetes and dementia have some similar physiological patterns, and glitazones may help reduce dementia in part because of their favourable effect on the body’s vascular system, the researchers said.
Study details
Use of oral diabetes medications and the risk of incident dementia in US veterans aged ≥60 years with type 2 diabetes
Xin Tang, Roberta Diaz Brinton, Zhao Chen, Leslie V Farland, Yann Klimentidis, Raymond Migrino, Peter Reaven, Kathleen Rodgers, Jin J Zhou.
Published in British Medical Journal Volume 10 issue 5
Abstract
Introduction
Studies have reported that antidiabetic medications (ADMs) were associated with lower risk of dementia, but current findings are inconsistent. This study compared the risk of dementia onset in patients with type 2 diabetes (T2D) treated with sulfonylurea (SU) or thiazolidinedione (TZD) to patients with T2D treated with metformin (MET).
Research design and methods
This is a prospective observational study within a T2D population using electronic medical records from all sites of the Veterans Affairs Healthcare System. Patients with T2D who initiated ADM from January 1, 2001, to December 31, 2017, were aged ≥60 years at the initiation, and were dementia-free were identified. A SU monotherapy group, a TZD monotherapy group, and a control group (MET monotherapy) were assembled based on prescription records. Participants were required to take the assigned treatment for at least 1 year. The primary outcome was all-cause dementia, and the two secondary outcomes were Alzheimer’s disease and vascular dementia, defined by International Classification of Diseases (ICD), 9th Revision, or ICD, 10th Revision, codes. The risks of developing outcomes were compared using propensity score weighted Cox proportional hazard models.
Results
Among 559 106 eligible veterans (mean age 65.7 (SD 8.7) years), the all-cause dementia rate was 8.2 cases per 1000 person-years (95% CI 6.0 to 13.7). After at least 1 year of treatment, TZD monotherapy was associated with a 22% lower risk of all-cause dementia onset (HR 0.78, 95% CI 0.75 to 0.81), compared with MET monotherapy, and 11% lower for MET and TZD dual therapy (HR 0.89, 95% CI 0.86 to 0.93), whereas the risk was 12% higher for SU monotherapy (HR 1.12 95% CI 1.09 to 1.15).
Conclusions
Among patients with T2D, TZD use was associated with a lower risk of dementia, and SU use was associated with a higher risk compared with MET use. Supplementing SU with either MET or TZD may partially offset its prodementia effects. These findings may help inform medication selection for elderly patients with T2D at high risk of dementia.
Bloomberg article – Older Diabetes Drugs Linked to Lower Dementia Risk (Open access)
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