Dulaglutide is linked to reduced cognitive impairment with T2D

  • Cukierman-Yaffe T & al.
  • Lancet Neurol
  • 1 Jul 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • The glucose-lowering glucagon-like peptide-1 (GLP-1) receptor agonist dulaglutide could reduce cognitive impairment in people age ≥50 years with type 2 diabetes (T2D).

Why this matters

  • Diabetes is an independent risk factor for cognitive impairment.

Study design

  • Data for 8828 participants age ≥50 years in REWIND, a randomized, double-blind, placebo-controlled, multicenter international trial of patients with T2D with HbA1c ≤9.5% and additional cardiovascular risk factors.
  • Cognitive function was assessed at baseline and at 2-year, 5-year, and end-of-study visits.
  • Assessments: Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST).
  • Funding: Eli Lilly and Company.

Key results

  • Incidence of primary cognitive outcome (first occurrence of follow-up score on MoCA or DSST of ≥1.5 standard deviations below baseline mean score in participant's country):
    • 4.05 per 100 patient-years with dulaglutide vs
    • 4.35 per 100 patient-years with placebo.
    • Adjusted (a)HR, 0.93 (P=.11).
  • After post hoc adjustment for baseline MoCA and DSST standardized scores, dulaglutide group had a 14% lower hazard of substantive cognitive impairment (SCI) vs those assigned to placebo (aHR, 0.86; P=.0018).

Limitations

  • Exploratory data.
  • 2-year interval between baseline and first subsequent test.
  • Adjustment of SCI outcome for baseline scores was not prespecified.
  • Only 2 cognitive tests used.
  • No prestudy cognitive status information.