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.

Details

Title
Use of oral diabetes medications and the risk of incident dementia in US veterans aged ≥60 years with type 2 diabetes
Author
Tang, Xin 1   VIAFID ORCID Logo  ; Roberta Diaz Brinton 2 ; Chen, Zhao 1 ; Farland, Leslie V 1 ; Klimentidis, Yann 3 ; Migrino, Raymond 4 ; Reaven, Peter 5 ; Rodgers, Kathleen 6 ; Zhou, Jin J 7 

1  Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA 
2  UA Center for Innovation in Brain Science, The University of Arizona Health Sciences, Tucson, Arizona, USA 
3  Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA 
4  Division of Cardiology, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA; Division of Endocrinology, Phoenix VA Health Care System, Phoenix, Arizona, USA 
5  Division of Endocrinology, Phoenix VA Health Care System, Phoenix, Arizona, USA; Division of Endocrinology, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA 
6  Department of Pharmacology and Toxicology, The University of Arizona, Tucson, Arizona, USA 
7  Department of Medicine, University of California, Los Angeles, California, USA; Department of Biostatistics, University of California, Los Angeles, California, USA 
First page
e002894
Section
Cardiovascular and metabolic risk
Publication year
2022
Publication date
2022
Publisher
BMJ Publishing Group LTD
e-ISSN
20524897
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1136/bmjdrc-2022-002894
ProQuest document ID
2724092381
Copyright
© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.