Association of sodium-glucose cotransporter-2 inhibitors with time to dementia: a population-based cohort study

Objective

Type 2 diabetes increases dementia risk, but clear evidence to recommend interventions that can mitigate that risk remains lacking. This population-based retrospective cohort study aimed to determine whether new use of sodium-glucose cotransporter-2 (SGLT2) inhibitors compared to dipeptidyl peptidase-4 (DPP4) inhibitors was associated with lower dementia risk.

Research Design and Methods 

Ontario residents aged ≥66 years who were new users of an SGLT2 inhibitor or a DPP4 inhibitor from July 1st, 2016 to March 31st, 2021 entered the cohort. Incident dementia was identified using a validated algorithm for Alzheimer’s disease and related dementias. Propensity-score weighted Cox proportional hazards models were used to obtain adjusted hazard ratios (aHR) and confidence intervals (CI) for time to incident dementia. To address reverse causality and disease latency, the observation window started at 1-year lag-time from cohort entry. The primary analysis followed intention-to-treat exposure definition, and a secondary as-treated analysis was performed.

Results 

Among 106,903 individuals, SGLT2 inhibitors compared with DPP4 inhibitors were associated with lower risk of dementia (14.2/1000 person-years; aHR [95% CI]=0.80 [0.71-0.89]) over a mean follow-up of 2.80 years from cohort entry. When stratified by different SGLT2 inhibitors, dapagliflozin exhibited the lowest risk (aHR [95% CI]=0.67 [0.53-0.84]), followed by empagliflozin (aHR [95% CI]=0.78 [0.69-0.89]), whereas canagliflozin showed no association (aHR [95% CI]=0.96 [0.80-1.16]). The as-treated analysis observed a larger association (aHR [95% CI]=0.66 [0.57-0.76]) than the intention-to-treat analysis.

Conclusions 

SGLT2 inhibitors showed an association with lower dementia risk in older people with type 2 diabetes. Randomized controlled trials are warranted.