If you have Type 2 diabetes, you likely know about or have taken an anti-hyperglycemic medication–but did you know that diabetes medications may affect your risk of developing multiple sclerosis (MS)?
Multiple sclerosis (MS) is a neurologic and autoimmune disease that affects the brain, spinal cord, and optic nerves and leads to severe physical and cognitive impairment. Scientists don’t know exactly what causes MS; however, it is known that some factor causes the nervous system to attack the central nervous system. 
Diabetes can harm the brain in a variety of ways. It is linked to the development of other neurodegenerative diseases such as dementia. High blood sugar is associated with inflammation, which can harm brain cells. The disease also increases the risk of heart disease and stroke, which damages the heart and blood vessels, including blood vessels in the brain, and may cause cognitive decline. Additionally, increased amounts of insulin in the body, caused by insulin resistance, can cause an imbalance in other brain chemicals.
Research has also shown a connection between a history of Type 1 and Type 2 diabetes and a new diagnosis of MS. A study conducted in Taiwan showed that patients with Type 2 diabetes had a greater chance of developing newly diagnosed MS than those who did not have diabetes.
If that’s the case, can diabetes medications lower your risk of dementia and MS?
The answer to this question is not straightforward.
University of Arizona researchers previously investigated the role of anti-hyperglycemic drugs (diabetes drugs) and the risk of dementia. They discovered that anti-hyperglycemic medications were associated with a reduced risk of developing Alzheimer’s disease and other dementia. MS was also included in the research, but the results related to anti-hyperglycemic medications’ effect on MS were not included in the published version of the study. 
Kathleen Rodgers, Ph.D., University of Arizona Professor, and co-author of the study told The Epoch Times that diabetes is one of the risk factors for all dementia. Her research showed that anti-hyperglycemic medications for people 45 and older were protective against Alzheimer’s disease and other neurodegenerative diseases in those suffering from Type 2 diabetes—except for MS. 
“MS stood out as separate,” explained Rogers. 
This finding led these researchers to take a separate look at the effects of anti-hyperglycemic medications and the risk of MS. 
A new study published in October 2022 focused on anti-hyperglycemic medications and the associated risk of developing MS. The study found that people—especially women—who were treated for Type 2 diabetes with anti-hyperglycemic medications after age 45 had an increased risk of developing MS. 
Interestingly, people younger than 45 and treated with anti-hyperglycemic medications showed a decreased risk of MS.
The study was conducted using information gathered from the Mariner claims database, one of the largest healthcare databases of HIPAA-compliant patient records. Participants with a prior history of neurodegenerative disease, including MS, were excluded from the study. Patient records meeting this criteria were reviewed to identify patients who had a diagnosis of MS 12 months or more after a documented diagnosis of Type 2 diabetes.  
Over 5 million patients were initially evaluated for participation in the study with a total of over 1.5 million ultimately being selected. These patients were broken into two subgroups—with a diagnosis of Type 2 diabetes prior to and after the age of 45. Additionally, each age group was divided into two new groups based on whether they were taking anti-hyperglycemic medications. 
Study Group
(at onset of Type 2 diabetes)
Anti-hyperglycemic Medications
Anti-hyperglycemic Medications
Patients in the treatment group received anti-hyperglycemic medication following their diagnosis of Type 2 diabetes. Medications included insulin, metformin, glitazones, sulfonylureas, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide agonists, DPP4 inhibitors, glinides, or combination therapies (for example, using both metformin and sulfonylureas). 
Patients under 45 who were treated with hyperglycemic medication had a 78 percent decreased risk of developing MS over an average follow-up of 6.2 years. Those taking sulfonylureas alone or with metformin had a significant decrease in the risk of new MS. Comparable reduction in MS risk was seen in all other anti-hyperglycemic drug classes. 
Patients over 45 had a 36 percent increased risk of MS, and women were more impacted. This was true for all drug classes. Patients who were taking insulin showed even more of a likelihood of developing MS. It is possible that the older, insulin-dependent diabetics were at an increased risk of developing MS due to other factors, including more severe disease, poorer control of glucose (with resultant increased inflammation) or lower socioeconomic status. 
According to the National Multiple Sclerosis Society, women are three times more likely to develop MS than their male counterparts. 
To make matters worse, the likelihood of developing MS seems to be increasing in recent decades, especially for women, and women over 50. A study conducted in Denmark showed that MS in women has doubled while men only saw a modest increase in cases during the same time period. 
Studies have also shown that women have a more active immune system and a higher risk of developing an autoimmune disease
As women age and enter perimenopause and menopause it appears that a decrease in estrogen correlates with an increase in inflammation within the body. Female diabetics often experience a worsening of symptoms during menopause, as changes in hormones make it more difficult to control blood sugar levels which can also increase inflammation of the body, including the brain. Diabetes and MS are both associated with inflammation
But “it’s not just the hormonal system,” explained Rodgers. One of the theories is “there is dysregulation in a lot of systems during menopause.”
The study led researchers to infer that the risk of MS was influenced by sex and age more than the anti-hyperglycemic drug class. 
This is partly because of the type of MS and the frequency that is typically diagnosed in the two different age groups.
The type of MS that typically affects young people are relapsing-remitting MS, and this accounts for approximately 85 percent of all MS cases. Late-onset MS which developed in older people is usually another type, called primary progressive MS.
According to Rodgers, the mechanisms driving late-onset MS remain “misunderstood” but could explain why Type 2 anti-hyperglycemic medications increase the risk of MS in older people. 
Unfortunately, they could not assess the type of MS with this data set. Although the study accounted for many MS risk factors beyond drug exposure, “there are factors that cannot be addressed with this database,” said Rodgers.
Rodgers admitted that their work “can only hypothesize” about what drives the study’s observations. 
Does this mean older people should reconsider taking anti-hyperglycemic medications? Or that younger people with diabetes should take these drugs? The answer is not clear-cut. 
Rodgers suggests that patients should bring up a family history or genetic risk factor with their doctor if they have diabetes. On the flip side, she says that MS is not common enough that patients should take medications that might have consequences if they don’t need to. 
Rodgers said she would hate to see older people go off their medications because of the study results and would like to see the same information repeated in other studies. 
According to Rodgers, what is most important for overall health is controlling diabetes. 
“Treating with meds is better [than without] if you can’t control [diabetes] with diet and exercise,” said Rodgers.
Diabetes occurs because the pancreas doesn’t make enough insulin, or cells do not respond as they should to insulin. Insulin is a hormone that helps the body convert sugar in your bloodstream into energy. If there is not enough insulin or the body cannot react to insulin normally (insulin resistance), the result is high blood sugar levels. 
Many cases of Type 2 diabetes can often be managed with diet and exercise. A diet focused on high-fiber, low-fat foods—such as fruits, vegetables, and whole grains—can help control blood sugar. This is because high-fiber foods have a low glycemic index, which means they help prevent spikes in insulin and help stabilize blood sugar. 
Exercise, while important for overall health, also can help control blood sugar. Physical activity causes blood glucose to be used for energy, thereby lowering total blood sugar. According to the Centers for Disease Control and Prevention, people should aim for at least 150 minutes of moderate-intensity exercise each week. Moderate-intensity exercise includes such activities as swimming, walking, and biking—but other day-to-day activities—like housework or yard work also count as moderate-intensity activities.
Diet and exercise can help with weight loss, which can also help lower blood sugar levels, by increasing insulin production and helping your body to be less insulin resistant. This allows some people to cut back on the use of anti-hyperglycemic medications or even reverse Type 2 diabetes. 
Rodgers says that blood sugar is usually more stable when it is treated with diet and exercise. The reason is that patients treated with medication have more fluctuations in blood sugar, especially those taking insulin. 
“Shifts in glucose along with hormonal shifts may set the immune system up to have an increased risk of this autoimmune disease,” explained Rogers. 
But, treating diabetes with medication is better if you can’t control it with diet and exercise, said Rodgers. “You are reducing your body’s overall body’s inflammation if you are controlling your hyperglycemia.” 
Also, not every case of Type 2 diabetes can be managed with diet, exercise, and weight loss.
That being said, “I think that is always healthier to do to try and maintain your blood sugar and HbAIc through diet and exercise,” said Rodgers, “You are going to have benefits irrespective of your risk factor for multiple sclerosis.”


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