Risk of Dementia in Older Patients with Type 2 Diabetes on Dipeptidyl-Peptidase IV Inhibitors Versus Sulfonylureas: A Real-World Population-Based Cohort Study

• Published in: Journal of clinical medicine Vol. 8; no. 1; p. 28
• Main Authors: Kim, Young-Gun, Jeon, Ja Young, Kim, Hae Jin, Kim, Dae Jung, Lee, Kwan-Woo, Moon, So Young, Han, Seung Jin
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 28.12.2018; MDPI AG
• Subjects: Alzheimer’s disease; dementia; diabetes mellitus; dipeptidyl-peptidase IV inhibitors; type 2; vascular; dementia; diabetes mellitus; type 2; Alzheimer’s disease; dipeptidyl-peptidase IV inhibitors; vascular
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm8010028

Type 2 diabetes is related to an increased risk of dementia. Preclinical studies of dipeptidyl peptidase-IV inhibitors (DPP-4i) for dementia have yielded promising results. Therefore, we investigated the risk of dementia in elderly patients with type 2 diabetes on DPP-4is and sulfonylureas (SU). Using a claims database called the Korean National Health Insurance Service Senior cohort, new users of DPP-4is and SUs were matched by 1:1 propensity score matching using 49 confounding variables (7552 new DPP-4is users and 7552 new SU users were matched by 1:1 propensity score matching; average age 75.4; mean follow-up period: 1361.9 days). Survival analysis was performed to estimate the risk of dementia. The risk of all-cause dementia was lower in the DPP-4i group compared to the SU group (hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.56⁻0.78; < 0.001). Particularly, DPP-4i use showed a significantly lower risk of Alzheimer's disease (HR 0.64; 95% CI 0.52⁻0.79; < 0.001) and a lower risk, albeit non-significant, of vascular dementia compared to SU use (HR 0.66; 95% CI 0.38⁻1.14; = 0.139). Our findings suggest that DPP-4i use decreases the risk of dementia compared to SU use in elderly patients with type 2 diabetes in a real-world clinical setting.