Elderly diabetics have lower risk of dementia with DPP 4 inhibitors vs sulfonylureas

Use of oral hypoglycemic agent Dipeptidyl peptidase-4 inhibitors (DPP-4i)decreases the risk of dementia compared to sulfonylureas(SU) use in elderly patients with type 2 diabetes in a real-world clinical setting.

A population-based study published in the Journal of Clinical Medicine demonstrated that use of DPP-4i was associated with a 34% lower risk of all-cause dementia compared with the use of SUs in older patients with type 2 diabetes. Indeed, DPP-4i use was related to a significantly lower risk of Alzheimer’s disease, but not vascular dementia, compared with SU use.

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Epidemiological evidence indicates that diabetes is associated with an increased risk of dementia, including Alzheimer’s disease and vascular dementia.

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are widely used oral hypoglycemic agents associated with a low risk of hypoglycemia and weight gain. In a recent cross-sectional study, higher DPP-4 plasma activity was associated with an increased risk of mild cognitive impairment in elderly patients with type 2 diabetes. This suggests that DPP-4is may be effective against cognitive dysfunction in individuals with type 2 diabetes.

According to the authors, no clinical study on the effect of DPP-4is on the incidence of dementia in type 2 diabetes has been reported.

Young Kim and associates investigated the risk of dementia in older patients on DPP-4is compared with SUs in a population-based cohort study using a national health insurance database.

Patients were included in the cohort if they were aged >60 years with type 2 diabetes and started taking a DPP-4i or SU.

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The investigators found that during the study period, 565 patients had newly developed dementia, among whom 367 had Alzheimer’s disease and 54 vascular dementia. When dementia was defined by diagnosis codes, the risk of all-cause dementia was lower in the DPP-4i group compared to the SU group. Moreover, when dementia was defined using both diagnosis codes and medications, similar trends were observed; that is, the DPP-4i group also had a lower risk of all-cause dementia and Alzheimer’s disease.

Type 2 diabetes and dementia are prevalent in the elderly and have considerable impacts on public health and patient quality of life. Recent estimates suggest that 382 million and 44 million individuals worldwide are affected by type 2 diabetes and dementia, respectively.