SGLT-2 inhibitors have been linked with a 35% lower dementia risk in a recent study.
- People
who have type 2 diabetes are at an increased risk of developing dementia.
- A
recent study investigates how a diabetes medication may affect this risk.
- The
scientists behind the study focused on sodium-glucose cotransporter-2
(SGLT-2) inhibitors, which they found significantly reduced dementia risk
compared with another diabetes drug.
- The
longer an individual had been taking the drug, the greater the protective
effect was.
The results of a new large-scale study published
in The BMJ suggest that a relatively new
diabetes drug might reduce the risk of developing dementia in people with type
2 diabetes.
Taking SGLT-2 inhibitors was
associated with a 35% lower risk of developing dementia compared
with taking another common diabetes drug with a different mechanism.
Although the authors
call for more research, as dementia prevalence is on the rise, the results of
the current study are encouraging.
How are type
2 diabetes and dementia linked?
Currently, the world is
experiencing what some researchers have termed a “dementia epidemic.” The primary risk factor for dementia is
aging. So, as the average age of the population increases, so does the number
of dementia cases.
Aging is not the only
risk factor, however. According to recent research, developing type 2 diabetes is
linked to an increase in the risk of developing dementia of 50%.
Because type 2 diabetes
is on the rise in the United States and elsewhere, this may also help fuel the
epidemic.
Speaking to Medical
News Today asked Raj Dasgupta, MD, chief medical advisor for Fortune Recommends
Health, who was not involved in the current study, explained why the two conditions
are linked. He said that:
“People
with type 2 diabetes have a higher risk of dementia because the same
cardiovascular problems that increase the risk of type 2 diabetes also increase
the risk of dementia. The main problem is that high blood sugar levels over
time can damage blood vessels in the brain, leading to less blood and oxygen
reaching brain cells.”
According to Dasgupta,
the resulting brain cell damage can cause cognitive decline and increase the
risk of vascular dementia — a form of dementia characterized by disruption to
the brain’s blood supply.
He also explained that
insulin resistance, which is a hallmark of type 2 diabetes, “affects brain
cells and is linked to a higher chance of Alzheimer’s disease.”
Dasgupta further
told MNT that other factors associated with type 2 diabetes
can increase dementia risk, including:
- inflammation
- oxidative
stress
- high
blood pressure
- obesity.
What are SGLT-2 inhibitors?
SGLT-2 inhibitors are
relatively new drugs that treat type 2 diabetes. The first SGLT-2 inhibitor
approved for use in the United States was dapagliflozin (Farxiga), in 2014.
These drugs stop the kidneys from reabsorbing as
much glucose, allowing the body to remove the glucose in urine rather than it
re-entering the blood.
Doctors now regularly
prescribe SGLT-2 inhibitors to treat diabetes if their current medication is
not controlling their condition adequately. Currently, around 1 in 10 people in the U.S. with type 2 diabetes take
these medications.
A range of FDA-approved
SGLT-2 inhibitors are now available, including canagliflozin (Invokana), empagliflozin (Jardiance),
and ertugliflozin
(Steglatro).
Beyond their benefits
for people with type 2 diabetes, some studies suggest these drugs might
also reduce the risk of dementia.
However, according to
the authors of the latest study, this previous research has significant gaps.
To build a clearer picture, they conducted a large-scale observational study.
Comparing
diabetes drugs’ effect on dementia risk
To investigate the
drug’s links to dementia risk, the researchers compared people with type 2
diabetes taking SGLT-2 inhibitors with those taking dipeptidyl
peptidase-4 (DPP-4) inhibitors.
DPP-4 inhibitors are
another class of anti-diabetes drugs with a different mechanism. These oral
medications work by increasing levels of glucagon-like peptide-1 (GLP-1), which
increases insulin production, thereby reducing blood sugar levels.
The scientists used
Korean National Health Insurance Service data from 2013–2021. This included
110,885 people with type 2 diabetes ages 40–69, all of whom were taking either
SGLT-2 or DPP-4 inhibitors.
They matched
participants for age and sex, and controlled for a wide range of variables,
including income, ongoing medical conditions, and other dementia risk factors,
like smoking.
During follow-up, which
was an average of 670 days, there were 1,172 new diagnoses of dementia within
the participants.
35%
reduction in dementia risk with SGLT-2 inhibitors
Compared with those
taking DPP-4 inhibitors, participants on SGLT-2 inhibitors had a 35% reduced
risk of developing dementia.
When the scientists looked at dementia subtypes,
they found that SGLT-2 inhibitors were linked to 52% lower risk of vascular
dementia, and 39% lower risk of Alzheimer’s disease.
Importantly, the risk
reduction was most pronounced in those who had been taking SGLT-2 inhibitors
for longer — more than 2 years compared with less than 2 years.
Overall, the authors
conclude that “SGLT-2 inhibitors might prevent dementia, providing greater
benefits with longer treatment.”
However, because the
study was observational, they explain that the effect size might be
“overestimated.” Nevertheless, because the study was large, and the effect was
clear in all the subgroups, the results are relatively robust.
Even so, the scientists
call for randomized controlled trials to confirm their findings.
How can
people with diabetes lower their dementia risk?
Akhil Shenoy,
MD, an endocrinologist and medical advisor at Aeroflow Diabetes,
explained to MNT how people with type 2 diabetes can reduce
their dementia risk.
He suggested “maintaining normal blood pressure and
blood sugar levels, a healthy body weight, and at least low to moderate levels
of physical activity.”
Shenoy, who was not
involved in the study, also advised people to avoid tobacco.
MNT also spoke to Angel Luk, RD,
a registered dietitian and nutritionist who was not involved in the study, asking
about dietary interventions that might reduce risk.
“Reducing alcohol intake, eating more fiber-rich
foods such as whole grains, vegetables, and fruit, and finding practical ways
to manage stress” are important, she said.
Finally, MNT spoke
with Clifford Segil, a neurologist at Providence Saint John’s
Health Center in Santa Monica, CA, who was not involved in the study.
“People with diabetes
who monitor their glucose levels and use medications are more likely to avoid
organ damage, including kidney damage, nerve damage, and vascular dementia,” he
said.
If future research
confirms the results of the latest study, SGLT-2 inhibitors may also be a
useful tool to help stem the dementia epidemic. However, while dementia risk is
higher in people with type 2 diabetes, it is not inevitable.
Managing diabetes with
medication, and making healthy lifestyle changes could significantly reduce a
person’s dementia risk.
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