Dementia risk does not differ with GLP-1 RAs, DPP4is for seniors with type 2 diabetes, study finds

For older adults with diabetes, there is no clear evidence to suggest that the incidence of dementia differs for those using glucagon-like peptide 1 receptor agonists (GLP-1 RAs) versus dipeptidyl peptidase-4 inhibitors (DPP4is), according to a study published online in the Annals of Internal Medicine.

Kosuke Inoue, M.D., Ph.D., from Kyoto University in Japan, and colleagues compared the effect of GLP-1 RAs to DPP4is as second-line therapy for type 2 diabetes on the risk of dementia in a target trial emulation. Participants included Medicare fee-for-service beneficiaries aged 66 years or older who used metformin and initiated GLP-1 RAs or DPP4is between January 2017 and December 2018.

The analyses included 2,418 patients initiating GLP-1 RAs and 4,836 propensity score-matched patients initiating DPP4is (mean age, 71 years). The researchers found that during a median follow-up of 1.9 years, the outcome of dementia onset occurred in 96 and 217 patients in the GLP-1 RA and DPP4i groups, respectively.

At 30 months, the estimated risk difference was −0.93 (95% confidence interval, −2.33 to 0.23) percentage points and the estimated risk ratio was 0.83 (95% confidence interval, 0.61 to 1.05). For those younger than 75 years and those 75 years and older, the estimated risk ratios were 0.64 (95% confidence interval, 0.46 to 0.93) and 1.22 (95% confidence interval, 0.74 to 1.66), respectively.

“Although there was a signal of lower incidence of dementia with GLP-1 RAs than with DPP4is among adults younger than 75 years, the causal relationship remains unclear,” the authors write.

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