- Metformin (Glucophage, others) is associated with a lower risk for dementia than sulfonylureas among patients receiving first-line treatment for type 2 diabetes mellitus (T2DM).
Why this matters
- Dementia risk is 70% higher for diabetic patients relative to nondiabetic peers.
- Respective median follow-up times to dementia in Veterans Health Affairs and Kaiser Permanente Washington cohorts:
- 4.6 and 7.6 years in metformin users.
- 4.7 and 7.1 years in sulfonylurea users.
- Compared with sulfonylurea initiation, metformin initiation netted lower risk of dementia in both cohorts:
- Veterans Health Affairs cohort (adjusted HR, 0.93; 95% CI, 0.87-0.99).
- Kaiser Permanente Washington cohort (adjusted HR, 0.89; 95% CI, 0.74-1.07).
- Findings were similar in:
- Moderator analyses further adjusted for average monthly glycemic burden or hypoglycemic events.
- Sensitivity analyses allowing mild cognitive impairment to contribute to the dementia outcome.
- Among patients ≥75 years, dementia risk did not differ significantly between drugs.
- Retrospective cohort study with 2 cohorts of patients ≥50 years who were dementia-free at baseline and had not received diabetes medication for 2 years prior to study entry.
- Participants initiated monotherapy with metformin or a sulfonylurea:
- 75,187 Veterans Health Affairs patients.
- 10,866 Kaiser Permanente Washington patients.
- Main outcome: dementia.
- Funding: National Institute on Aging.
- Unmeasured, residual confounding.
- Uncertain generalizability.
- Dementia ascertained from diagnosis codes.