GLP-1RA and SGLT2i Medications for Type 2 Diabetes and Alzheimer Disease and Related Dementias

🥇 Top 1% JournalApr 7, 2025JAMA neurology

GLP-1RA and SGLT2i Diabetes Medications and Their Links to Alzheimer’s Disease and Related Dementias

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Abstract

Among 33,858 patients using glucagon-like peptide-1 receptor agonists (GLP-1RAs), the incidence rate of Alzheimer disease and related dementias (ADRD) was 2.26 lower per 1000 person-years compared to other glucose-lowering drugs.

In those using sodium-glucose cotransporter-2 inhibitors (SGLT2is), the ADRD incidence rate was 3.05 lower per 1000 person-years compared to other glucose-lowering drugs.
GLP-1RA initiators had a hazard ratio (HR) of 0.67, suggesting a potential 33% reduction in ADRD risk compared to other glucose-lowering drug initiators.
SGLT2i initiators had an HR of 0.57, indicating a potential 43% reduction in ADRD risk compared to other glucose-lowering drug initiators.
No significant difference in ADRD risk was found between GLP-1RA and SGLT2i users, with an HR of 0.97.
The findings are based on electronic health record data from patients aged 50 years or older with type 2 diabetes.

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IMPORTANCE: The association between glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) and risk of Alzheimer disease and related dementias (ADRD) remains to be confirmed.

OBJECTIVE: To assess the risk of ADRD associated with GLP-1RAs and SGLT2is in people with type 2 diabetes (T2D).

DESIGN, SETTING, AND PARTICIPANTS: This target trial emulation study used electronic health record data from OneFlorida+ Clinical Research Consortium from January 2014 to June 2023. Patients were 50 years or older with T2D and no prior diagnosis of ADRD or antidementia treatment. Among the 396 963 eligible patients with T2D, 33 858 were included in the GLP-1RA vs other glucose-lowering drug (GLD) cohort, 34 185 in the SGLT2i vs other GLD cohort, and 24 117 in the GLP-1RA vs SGLT2i cohort.

EXPOSURES: Initiation of treatment with a GLP-1RA, SGLT2i, or other second-line GLD.

MAIN OUTCOMES AND MEASURES: ADRD was identified using clinical diagnosis codes. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazard regression models with inverse probability of treatment weighting (IPTW) to adjust for potential confounders.

RESULTS: This study included 33 858 patients in the GLP-1RA vs other GLD cohort (mean age, 65 years; 53.1% female), 34 185 patients in the SGLT2i vs other GLD cohort (mean age, 65.8 years; 49.3% female), and 24 117 patients in the GLP-1RA vs SGLT2i cohort (mean age, 63.8 years; 51.7% female). In IPTW-weighted cohorts, the incidence rate of ADRD was lower in GLP-1RA initiators compared with other GLD initiators (rate difference [RD], -2.26 per 1000 person-years [95% CI, -2.88 to -1.64]), yielding an HR of 0.67 (95% CI, 0.47-0.96). SGLT2i initiators had a lower incidence than other GLD initiators (RD, -3.05 per 1000 person-years [95% CI, -3.68 to -2.42]), yielding an HR of 0.57 (95% CI, 0.43-0.75). There was no difference between GLP-1RAs and SGLT2is, with an RD of -0.09 per 1000 person-years (95% CI, -0.80 to 0.63) and an HR of 0.97 (95% CI, 0.72-1.32).

CONCLUSION AND RELEVANCE: In people with T2D, both GLP-1RAs and SGLT2is were statistically significantly associated with decreased risk of ADRD compared with other GLDs, and no difference was observed between both drugs.

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