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SGLT-2 inhibitor drugs help patients manage diabetes by preventing the kidneys from reabsorbing sugars made by the body. Photo used for representational purpose only | Photo credit: Getty Images/iStockphoto
A study in Korea suggests that a common diabetes drug may prevent dementia, with longer-term treatment yielding greater benefits.
The study, conducted using data from South Korea’s national health insurance database, was published in the British Medical Journal.
Researchers found that among more than 200,000 adults aged 40-69 years with type 2 diabetes, taking a drug called a sodium glucose cotransporter 2 inhibitor, or SGLT-2 inhibitor, reduced the risk of dementia by 35 percent, while the risk was lower among those taking a dipeptidyl peptidase-4 inhibitor, or DPP-4 inhibitor, also known as gliptins.
In addition, treatment with SGLT-2 drugs was found to have more pronounced effects over a longer period of time – the risk of dementia decreased by 48 per cent after more than two years of treatment. Examples of SGLT-2 drugs available in India include remogliflozin and dapagliflozin, while DPP-4 drugs include sitagliptin, vildagliptin and teneligliptin.
The need for randomised controlled trials
However, the researchers, including those from Seoul National University Bundang Hospital, cautioned that the effects may be overestimated and said randomised controlled trials, or RCTs, are now needed to confirm these findings. RCTs are considered the gold-standard of clinical trials.
The team found that complete information was not available on health behaviours, such as smoking and alcohol habits, and the length of time patients had diabetes.
However, the authors pointed out that this was a large study based on nationally representative data, including relatively young people with type 2 diabetes, and the results were highly consistent across all subgroups.
SGLT-2 inhibitor drugs help diabetics by preventing the kidneys from reabsorbing sugar made by the body. The excess sugar is then removed through urine. On the other hand, DPP-4 inhibitor drugs work by blocking the DPP-4 enzyme, which helps the body increase insulin levels after a meal.
SGLT-2 drugs are commonly used to treat diabetes in India.
For the study, researchers used the Korea National Health Insurance Service database to identify more than 1.1 million adults who were an average of 62 years old and had type 2 diabetes, were free of dementia, and who started taking either an SGLT-2 or DPP-4 drug between 2013 and 2021. All participants were followed for about two years to see who developed dementia.
“This large population-based study among adults aged 40–69 years with type 2 diabetes found that use of SGLT-2 inhibitors compared with DPP-4 inhibitors reduced the risk of dementia by 35%,” the authors wrote.
The researchers also found that SGLT-2 reduced the risk of Alzheimer’s disease by 39 percent and the risk of vascular dementia by 52 percent, compared to DPP-4 inhibitors.
Alzheimer’s disease is the most common form of dementia, while in vascular dementia, brain function is affected due to damaged blood vessels, blocking blood flow and oxygen supply.
Additionally, the researchers found that patients who took the SGLT-2 drugs for more than two years had a 48 percent reduced risk of dementia, compared with a 43 percent reduced risk among those who took the drugs for two years or less.
The authors said the results suggest that longer duration of diabetes treatment with SGLT-2 drugs may have more pronounced effects.
No firm cause-and-effect conclusions were drawn
The authors said that because this was an observational study, no firm cause-and-effect conclusions could be drawn, and called for randomised controlled trials to confirm their findings.
Participants taking the SGLT-2 drugs had an average dementia incidence rate of 0.22 per 100 people over a one-year period, according to the study. Those taking the DPP-4 inhibitor drugs had an average dementia incidence rate of 0.35 per 100 people over a one-year period, according to the study.
A study published in February in the journal One moreA study estimates that 34 million senior citizens in India aged 60 years and above are living with mild cognitive impairment — a pre-dementia stage — that is affecting their daily lives and activities in some way or the other.
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