Impact of hypoglycemic agents on glycemic control and cognitive decline in older adults with type 2 diabetes: real-world evidence on glucagon like peptide 1 receptor agonists

Apr 2, 2026Minerva endocrinology

Effects of blood sugar medicines on blood sugar control and memory loss in older adults with type 2 diabetes, focusing on GLP-1 receptor drugs

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Abstract

After one year of treatment, HbA1c levels significantly decreased from 8.06% to 7.19% in older patients with type 2 diabetes mellitus.

Cognitive function, as measured by the MMSE, improved significantly, with scores rising from 25.87 to 27.47.
GLP-1 receptor agonists (GLP-1RAs) were identified as the most effective agents for improving both glycemic control and cognitive function.
The reduction in MMNA scores associated with GLP-1RAs remained above the malnutrition threshold.
Findings indicate that improved glycemic control may be linked to a slowdown in cognitive decline in older adults with T2DM.

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BACKGROUND: Type 2 diabetes mellitus (T2DM) is frequently associated with cognitive decline in the older population. Although optimal glycemic control is known to be essential for disease management, the impact of hypoglycemic agents on cognitive function remains poorly investigated.

METHODS: This retrospective study included 93 geriatric outpatients with T2DM. Hypoglycemic treatments consisted of metformin, sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 inhibitors, and insulin. Patient evaluations included glycated hemoglobin (HbA1c) measurements, Standardized Mini-Mental State Examination (MMSE), and Mini Nutritional Assessment (MNA).

RESULTS: After one year of treatment, patients exhibited a significant reduction in HbA1c levels (from 8.06% [±1.19] to 7.19% [±0.84], P<0.001), improvement of MMSE scores (from 25.87 [±3.09] to 27.47 [±2.9], P<0.001). Regression analysis identified GLP-1RAs as the most effective agent in improving glycemic control (P<0.001) and cognitive function (P=0.016). Treatment with GLP-1RAs was associated with a reduction in MNA scores (P<0.001), though these remained above the malnutrition threshold.

CONCLUSIONS: Our findings suggest that improved glycemic control may help slow cognitive decline in older patients with T2DM. Among the drug classes examined, GLP-1RAs showed the largest reductions in HbA1c and were linked to greater MMSE score gains.

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Impact of hypoglycemic agents on glycemic control and cognitive decline in older adults with type 2 diabetes: real-world evidence on glucagon like peptide 1 receptor agonists

Abstract

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