Abstract
Background: Type 2 diabetes is related to an increased risk of dementia. Preclinical studies of dipeptidyl peptidase-IV inhibitors (DPP-4i) for dementia have yielded promising results. Therefore, we investigated the risk of dementia in elderly patients with type 2 diabetes on DPP-4is and sulfonylureas (SU). Methods: Using a claims database called the Korean National Health Insurance Service Senior cohort, new users of DPP-4is and SUs were matched by 1:1 propensity score matching using 49 confounding variables (7552 new DPP-4is users and 7552 new SU users were matched by 1:1 propensity score matching; average age 75.4; mean follow-up period: 1361.9 days). Survival analysis was performed to estimate the risk of dementia. Results: The risk of all-cause dementia was lower in the DPP-4i group compared to the SU group (hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.56–0.78; p < 0.001). Particularly, DPP-4i use showed a significantly lower risk of Alzheimer’s disease (HR 0.64; 95% CI 0.52–0.79; p < 0.001) and a lower risk, albeit non-significant, of vascular dementia compared to SU use (HR 0.66; 95% CI 0.38–1.14; p = 0.139). Conclusion: Our findings suggest that DPP-4i use decreases the risk of dementia compared to SU use in elderly patients with type 2 diabetes in a real-world clinical setting.
Highlights
Type 2 diabetes and dementia are prevalent in the elderly and have considerable impacts on public health and patient quality of life
CI, 95% confidence interval; HR, hazard ratio; N, number of patients; DM, diabetes mellitus. This population-based study demonstrated that use of Dipeptidyl peptidase-4 inhibitors (DPP-4i) was associated with a 34% lower risk of all-cause dementia compared with use of SUs in older patients with type 2 diabetes
DPP-4i use was related to a significantly lower risk of Alzheimer’s disease, but not vascular dementia, compared with SU use. This is the first report that DPP-4i use is associated with a lower risk of dementia in older patients with type 2 diabetes
Summary
Type 2 diabetes and dementia are prevalent in the elderly and have considerable impacts on public health and patient quality of life. Recent estimates suggest that 382 million and 44 million individuals worldwide are affected by type 2 diabetes and dementia, respectively [1,2]. According to a recent meta-analysis of 28 prospective observational studies, patients with diabetes have a 73% higher risk of dementia compared to those without diabetes [5]. Type 2 diabetes is related to an increased risk of dementia. We investigated the risk of dementia in elderly patients with type 2 diabetes on DPP-4is and sulfonylureas (SU). Results: The risk of all-cause dementia was lower in the DPP-4i group compared to the SU group (hazard ratio (HR) 0.66; 95% confidence interval (CI)
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