Glitazones, a family of type 2 diabetes drugs also known as thiazolidinediones, or TZDs for short, were associated with a 22 percent lower risk of dementia in a large long-term study.
Glitazones have been used for about 20 years to improve insulin sensitivity.
People with type 2 diabetes who use drugs known as glitazones to control their blood sugar levels may get another benefit — a lower risk of dementia and Alzheimer’s disease.
A study published October 11 in BMJ Open Diabetes Research & Care examined data on about 559,000 adults age 60 and older with type 2 diabetes who used at least one of three different types of drugs to manage blood sugar: glitazones, sulfonylureas, or metformin.
After an average follow-up period of almost seven years, patients who took glitazones for at least one year were 22 percent less likely to develop any form of dementia than people who took metformin. By contrast, sulfonylureas were associated with a 12 percent higher dementia risk than metformin.
“Our findings provide additional information to aid clinicians' selection of (blood-sugar-lowering medications) for patients with mild or moderate type 2 diabetes and at high risk of dementia,” the senior study author, Jin Zhou of the University of California in Los Angeles, and her colleagues concluded in the paper.
When researchers looked specifically at Alzheimer’s disease, the most common form of dementia, they found a protective effect with glitazones. Taken alone, glitazones were associated with an 11 percent lower Alzheimer’s disease risk. When used in combination with metformin, glitazones were associated with a 19 percent lower risk of Alzheimer’s disease. The combination of glitazones and sulfonylureas was associated with a 15 percent lower Alzheimer’s disease risk.
The protective effect of glitazones was most pronounced with longer-term use, among elderly patients, and among people with obesity.
One limitation of the analysis is that it relied on electronic health records to identify cases of dementia, making it possible that some undiagnosed cases influenced the results.
Another drawback is that during the study period, which spanned from 2000 to 2019, U.S. drug regulators temporarily restricted use of one glitazone drug — Avandia — because of heart risks, a factor that may have influenced the underlying medical conditions of patients using different types of medications to manage their blood sugar.
Avandia remains on the market, along with a similar drug, rosiglitazone (Actos) for use alone or in combination with metformin or sulfonylureas to manage type 2 diabetes. Both drugs are intended to be used along with lifestyle modifications like weight loss and improved eating and exercise habits, according to StatPearls.
While the current study wasn’t designed to prove how glitazones might directly prevent dementia, some previous research suggests that people with well-controlled type 2 diabetes may be able to minimize the risk of complications like blood vessel damage that can, over time, lead to cognitive decline and dementia.
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