Early termination of metformin treatment in older adults with type 2 diabetes is associated with a higher risk of dementia, according to a cohort study. The research has significant implications for diabetes management, especially among those at higher risk for dementia.
By Neha MathurOct 29 2023Reviewed by Sophia Coveney In a recent cohort study published in JAMA Network Open, researchers evaluated whether metformin treatment is associated with a reduced risk of all-cause dementia in people with type 2 diabetes .
According to current recommendations, people should carefully weigh the benefits versus risks of metformin therapy when the estimated glomerular filtration rate plummets below a certain threshold. The follow-up for dementia incidence began with the implementation of their EHRs in 1996 and continued till 2020. They censored participants at age 90, death, dementia diagnosis, or at the start of a 90-day membership gap.
All calculated P values were two-sided, and the statistical threshold of significance for proportional hazard assumptions was set at α=.05. The data was analyzed between November 2021 and September 2023. Further, they performed Cox proportional regression modeling to determine hazard ratios for dementia diagnosis using time since metformin termination as the time scale, stratified by age at metformin treatment initiation and gender.
Results and conclusions In total, 12,220 early terminators and 29,126 routine users, with a mean age of 59.4 and 61.1 years at the start of the first metformin prescription, respectively, were analyzed.Mediation analysis revealed that changes in HbA1c level or insulin use contributed to the association between early metformin termination and all-cause dementia, with no contribution for insulin use five years after metformin termination to 0.
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