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Drugs used to treat type 2 diabetes could reduce the risk of dementia, according to a long-term study published in the journal BMJ Open Diabetes Research & Care.
Glitazones (also known as thiazolidinediones or TZDs) are an older class of diabetes drug that work by reducing insulin resistance and improving insulin sensitivity, allowing the insulin that the body produces to work more effectively.
Since type 2 diabetes and dementia share some of the same physiological patterns, researchers have begun to look at whether diabetes drugs might help to stave off or treat dementia. However, the findings have been inconsistent.
The researchers therefore set out to compare the risk of dementia in patients with type 2 diabetes when treated with different drugs.
Use of a TZD alone was associated with a 22% lower risk of dementia
Using the electronic health records of more than 559,000 people diagnosed with type 2 diabetes from the national Veteran Affairs Health System, the researchers were able to analyse which drugs patients were given and track their health for an average of eight years.
Older adults (aged at least 60) who were given a first prescription of metformin, a sulfonylurea (tolbutamide, glimepiride, glipizide, or glyburide), or a TZD (rosiglitazone or pioglitazone) between January 2001 and December 2017 were included (559,106) in the study.
After at least one year of drug treatment, use of a TZD alone was associated with a 22% lower risk of dementia from any cause, compared with the use of metformin alone. More specifically, it was associated with an 11% lower risk of Alzheimer’s disease and a 57% lower risk of vascular dementia.
Taking both metformin and TZD together also lowered the risk of dementia by 11%. However, taking a sulfonylurea drug alone was associated with a 12% increased risk. The researchers therefore suggest that supplementing a sulfonylurea with either metformin or a TZD may partially offset these effects.
Those younger than 75 benefitted the most from a TZD, highlighting the importance of early prevention. Overweight and obese patients were also among those best protected.
The findings could be used to inform medication selection
The authors highlight that the study cannot establish a cause, but they say the findings may help to inform medication selection for older patients with type 2 diabetes at high risk of dementia.
They suggest that further studies will now be needed to confirm the findings, and they encourage researchers to closely look at TZDs as a method of dementia protection and prevention.