That was the question addressed in a new study comparing the risk for dementia between SGLT2i and dulaglutide (a GLP-1 RA). Researchers from Brigham and Women’s Hospital and Harvard Medical School joined colleagues in South Korea in an effort to answer that question.
The researchers target trial emulation study used nationwide healthcare data of South Korea obtained from the National Health Insurance Service between 2010 and 2022. The results were published in Annals of Internal Medicine.
The study included patients aged 60 years or older who have T2D and had initiated treatment with SGLT2i or dulaglutide. Overall, 12,489 patients started on SGLT2i treatment—51.9% dapagliflozin and 48.1% empagliflozin—and 1,075 patients started on dulaglutide. The primary outcome was defined as the presumed clinical onset of dementia.
Over a median follow-up of 4.4 years, the primary outcome event occurred in 69 participants in the SGLT2i group and 43 in the dulaglutide group, the researchers reported. The estimated risk difference was –0.91 percentage point (95% CI, –2.45 to 0.63 percentage point), and the estimated risk ratio was 0.81 (95% CI, 0.56-1.16).
“Under conventional statistical criteria, a risk for dementia between 2.5 percentage points lower and 0.6 percentage point greater for SGLT2 inhibitors than for dulaglutide was estimated to be highly compatible with the data from this study,” the researchers advised. “However, whether these findings generalize to newer GLP-1 RAs is uncertain. Thus, further studies incorporating newer drugs within these drug classes and better addressing residual confounding are required.”
The authors also cautioned that residual confounding is possible and that there was no adjustment for hemoglobin A1c levels or duration of diabetes. Furthermore, the authors noted that the study is not representative of newer drugs, including more effective GLP-1 RAs, and the onset of dementia was not measured directly.
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