Anti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trials
Abstract Objective To evaluate the association between anti-diabetic agents and the risks of dementia in patients with type 2 diabetes (T2D). Methods Literature retrieval was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials and Clinicaltrial.gov between January 1995 an...
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2024-12-01
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| Series: | Alzheimer’s Research & Therapy |
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| Online Access: | https://doi.org/10.1186/s13195-024-01645-y |
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| author | Zonglin Li Chu Lin Xiaoling Cai Fang Lv Wenjia Yang Linong Ji |
| author_facet | Zonglin Li Chu Lin Xiaoling Cai Fang Lv Wenjia Yang Linong Ji |
| author_sort | Zonglin Li |
| collection | DOAJ |
| description | Abstract Objective To evaluate the association between anti-diabetic agents and the risks of dementia in patients with type 2 diabetes (T2D). Methods Literature retrieval was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials and Clinicaltrial.gov between January 1995 and October 2024. Observational studies and randomized controlled trials (RCTs) in patients with T2D, which intercompared anti-diabetic agents or compared them with placebo, and reported the incidence of dementia were included. Conventional and network meta-analyses of these studies were implemented. Results were exhibited as the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI). Results A total of 41 observational studies (3,307,483 participants) and 23 RCTs (155,443 participants) were included. In the network meta-analysis of observational studies, compared with non-users, sodium glucose cotransporter-2 inhibitor (SGLT-2i) (OR = 0.56, 95%CI, 0.45 to 0.69), glucagon-like peptide-1 receptor agonist (GLP-1RA) (OR = 0.58, 95%CI, 0.46 to 0.73), thiazolidinedione (TZD) (OR = 0.68, 95%CI, 0.57 to 0.81) and metformin (OR = 0.89, 95%CI, 0.80 to 0.99) treatments were all associated with reduced risk of dementia in patients with T2D. The surface under the cumulative ranking curve (SUCRA) evaluation conferred a rank order as SGLT-2i > GLP-1RA > TZD > dipeptidyl peptidase-4 inhibitor (DPP-4i) > metformin > α-glucosidase inhibitor (AGI) > glucokinase activator (GKA) > sulfonylureas > glinides > insulin in terms of the cognitive benefits. Meanwhile, compared with non-users, SGLT-2i (OR = 0.43, 95%CI, 0.30 to 0.62), GLP-1RA (OR = 0.54, 95%CI, 0.30 to 0.96) and DPP-4i (OR = 0.73, 95%CI, 0.57 to 0.93) were associated with a reduced risk of Alzheimer’s disease while a lower risk of vascular dementia was observed in patients receiving SGLT-2i (OR = 0.42, 95%CI, 0.22 to 0.80) and TZD (OR = 0.52, 95%CI, 0.36 to 0.75) treatment. In the network meta-analysis of RCTs, the risks of dementia were comparable among anti-diabetic agents and placebo. Conclusion Compared with non-users, SGLT-2i, GLP-1RA, TZD and metformin were associated with the reduced risk of dementia in patients with T2D. SGLT-2i, and GLP-1RA may serve as the optimal choice to improve the cognitive prognosis in patients with T2D. |
| format | Article |
| id | doaj-art-b70a8acd3c7448a6948fd50efb1597fb |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | Alzheimer’s Research & Therapy |
| spelling | doaj-art-b70a8acd3c7448a6948fd50efb1597fb2024-12-29T12:12:31ZengBMCAlzheimer’s Research & Therapy1758-91932024-12-0116111610.1186/s13195-024-01645-yAnti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trialsZonglin Li0Chu Lin1Xiaoling Cai2Fang Lv3Wenjia Yang4Linong Ji5Department of Endocrinology and Metabolism, Peking University People’s HospitalDepartment of Endocrinology and Metabolism, Peking University People’s HospitalDepartment of Endocrinology and Metabolism, Peking University People’s HospitalDepartment of Endocrinology and Metabolism, Peking University People’s HospitalDepartment of Endocrinology and Metabolism, Peking University People’s HospitalDepartment of Endocrinology and Metabolism, Peking University People’s HospitalAbstract Objective To evaluate the association between anti-diabetic agents and the risks of dementia in patients with type 2 diabetes (T2D). Methods Literature retrieval was conducted in PubMed, Embase, the Cochrane Central Register of Controlled Trials and Clinicaltrial.gov between January 1995 and October 2024. Observational studies and randomized controlled trials (RCTs) in patients with T2D, which intercompared anti-diabetic agents or compared them with placebo, and reported the incidence of dementia were included. Conventional and network meta-analyses of these studies were implemented. Results were exhibited as the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI). Results A total of 41 observational studies (3,307,483 participants) and 23 RCTs (155,443 participants) were included. In the network meta-analysis of observational studies, compared with non-users, sodium glucose cotransporter-2 inhibitor (SGLT-2i) (OR = 0.56, 95%CI, 0.45 to 0.69), glucagon-like peptide-1 receptor agonist (GLP-1RA) (OR = 0.58, 95%CI, 0.46 to 0.73), thiazolidinedione (TZD) (OR = 0.68, 95%CI, 0.57 to 0.81) and metformin (OR = 0.89, 95%CI, 0.80 to 0.99) treatments were all associated with reduced risk of dementia in patients with T2D. The surface under the cumulative ranking curve (SUCRA) evaluation conferred a rank order as SGLT-2i > GLP-1RA > TZD > dipeptidyl peptidase-4 inhibitor (DPP-4i) > metformin > α-glucosidase inhibitor (AGI) > glucokinase activator (GKA) > sulfonylureas > glinides > insulin in terms of the cognitive benefits. Meanwhile, compared with non-users, SGLT-2i (OR = 0.43, 95%CI, 0.30 to 0.62), GLP-1RA (OR = 0.54, 95%CI, 0.30 to 0.96) and DPP-4i (OR = 0.73, 95%CI, 0.57 to 0.93) were associated with a reduced risk of Alzheimer’s disease while a lower risk of vascular dementia was observed in patients receiving SGLT-2i (OR = 0.42, 95%CI, 0.22 to 0.80) and TZD (OR = 0.52, 95%CI, 0.36 to 0.75) treatment. In the network meta-analysis of RCTs, the risks of dementia were comparable among anti-diabetic agents and placebo. Conclusion Compared with non-users, SGLT-2i, GLP-1RA, TZD and metformin were associated with the reduced risk of dementia in patients with T2D. SGLT-2i, and GLP-1RA may serve as the optimal choice to improve the cognitive prognosis in patients with T2D.https://doi.org/10.1186/s13195-024-01645-yAnti-diabetic agentsDementiaAlzheimer’s diseaseSodium-glucose cotransporter-2 inhibitorGlucagon-like peptide-1 receptor agonist |
| spellingShingle | Zonglin Li Chu Lin Xiaoling Cai Fang Lv Wenjia Yang Linong Ji Anti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trials Alzheimer’s Research & Therapy Anti-diabetic agents Dementia Alzheimer’s disease Sodium-glucose cotransporter-2 inhibitor Glucagon-like peptide-1 receptor agonist |
| title | Anti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trials |
| title_full | Anti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trials |
| title_fullStr | Anti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trials |
| title_full_unstemmed | Anti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trials |
| title_short | Anti-diabetic agents and the risks of dementia in patients with type 2 diabetes: a systematic review and network meta-analysis of observational studies and randomized controlled trials |
| title_sort | anti diabetic agents and the risks of dementia in patients with type 2 diabetes a systematic review and network meta analysis of observational studies and randomized controlled trials |
| topic | Anti-diabetic agents Dementia Alzheimer’s disease Sodium-glucose cotransporter-2 inhibitor Glucagon-like peptide-1 receptor agonist |
| url | https://doi.org/10.1186/s13195-024-01645-y |
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