Abstract
Background and aimsAnimal studies suggested that vildagliptin might exert a beneficial effect on cognitive function. The present study evaluated whether the use of vildagliptin in patients with type 2 diabetes mellitus might affect dementia risk.MethodsThe database of Taiwan’s National Health Insurance was used to enroll an unmatched cohort and a propensity score-matched-pair cohort of ever and never users of vildagliptin from patients with newly diagnosed diabetes mellitus during 2002-2014. The patients should be alive on January 1, 2015 and were followed up for dementia diagnosis until December 31, 2016. Unadjusted and multivariate-adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were estimated for vildagliptin ever versus never users, for cumulative duration and cumulative dose of vildagliptin therapy categorized into tertiles versus never users, and for cumulative duration and cumulative dose treated as continuous variables.ResultsThere were 355610 never users and 43196 ever users in the unmatched cohort and 40489 never users and 40489 ever users in the matched cohort. In the unmatched cohort, unadjusted HR (95% CI) was 0.929 (0.683-1.264) and the multivariate-adjusted HR (95% CI) was 0.922 (0.620-1.372). In the matched cohort, the unadjusted HR (95% CI) was 0.930 (0.616-1.402) and the multivariate-adjusted HR (95% CI) was 0.825 (0.498-1.367). None of the analyses conducted for cumulative duration and cumulative dose was significant, either being treated as tertile cutoffs or as continuous variables, in either the unmatched cohort or the matched cohort.ConclusionsThis study showed a neutral effect of vildagliptin on dementia risk.
Highlights
Both diabetes and dementia affect hundreds of millions of the world population
The findings suggested that vildagliptin use has a null association with dementia risk in patients with type 2 diabetes mellitus (Tables 2 and 3)
It is interesting that vildagliptin alleviated cognitive deficits of spatial learning and memory in rats with streptozotocin-induced diabetes [18], but this benefit could not be demonstrated in humans in the present study (Tables 2 and 3)
Summary
Both diabetes and dementia affect hundreds of millions of the world population. The International Diabetes Federation estimates that 463 million people or 1 in every 11 adults aged 20 to 79 years have diabetes mellitus over the world [1]. According to a meta-analysis that included 20 studies, diabetes mellitus is associated with an approximately 70% higher risk of all types of dementia [3]. Studies conducted in Taiwan using the reimbursement database of the National Health Insurance (NHI) showed a increased risk of dementia of 50% [4] to 60% [5] in the diabetes patients. The higher risk of dementia in diabetes patients may be explained by vascular and metabolic changes associated with hyperglycemia and diabetes-related comorbidities, including atherosclerosis, increased deposition of advanced glycation end-products, dysregulation of lipid metabolism, and augmented status of inflammation and oxidative stress [6, 7]. The present study evaluated whether the use of vildagliptin in patients with type 2 diabetes mellitus might affect dementia risk. Unadjusted and multivariate-adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were estimated for vildagliptin ever versus never users, for cumulative duration and cumulative dose of vildagliptin therapy categorized into tertiles versus never users, and for cumulative duration and cumulative dose treated as continuous variables
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