The Association Between Second-Line Oral Antihyperglycemic Medication on Types of Dementia in Type 2 Diabetes: A Nationwide Real-World Longitudinal Study

Article type: Research Article

Authors: Kim, Won Jun^a | Noh, Jung Hyun^b | Han, Kyungdo^c | Park, Cheol-Young^{d; *}

Affiliations: [a] Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea | [b] Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea | [c] Department of Biostatistics, College of Medicine, Catholic University, Seoul, Republic of Korea | [d] Department of Internal Medicine, Sungkyunkwan University, Kangbuk Samsung Hospital, Seoul, Republic of Korea

Correspondence: [*] Correspondence to: Cheol-Young Park, Department of Internal Medicine, Sungkyunkwan University, Kangbuk Samsung Hospital, Seoul, Republic of Korea. Tel.: +82 2 2001 2440; Fax:+82 2 2001 1588; E-mail: cydoctor@chol.com.

Abstract: Background:There are few reports that evaluated the association between various types of dementia and dual oral therapy with antihyperglycemic medication. Objective:The goal of this study was to investigate the association between treatment of dual antihyperglycemic medication and dementia subclass in type 2 diabetes mellitus using the Korean National Health Insurance System. Methods:This study included 701,193 individuals with diabetes prescribed dual oral therapy between 2009 and 2012 from the Korean National Health Insurance Service Database, which were tracked until 2017. All-cause, Alzheimer’s (AD) and vascular dementia (VaD) were investigated by dual oral therapy. Adjustments were made for age, sex, income, diabetes duration, hypertension, dyslipidemia, smoking, drinking, exercise, body mass index, glucose level, and estimated glomerular filtration rate. Results:Dual therapy with metformin (Met) + dipeptidyl peptidase-4 inhibitor (DPP-4i), Met + thiazolidinedione (TZD), and sulfonylurea (SU) + thiazolidinediones (TZD) were significantly associated with all-cause dementia (HR = 0.904, 0.804, and 0.962, respectively) and VaD (HR = 0.865, 0.725, and 0.911, respectively), compared with Met + SU. Met + DPP-4i and Met + TZD were associated with significantly lower risk of AD (HR = 0.922 and 0.812), compared with Met + SU. Dual therapy with TZD was associated with a significantly lower risk of all-cause dementia, AD, and VaD than nonusers of TZD (HR = 0.918, 0.925 and 0.859, respectively). Conclusion:Adding TZD or DPP-4i instead of SU as second-line anti-diabetic treatment may be considered for delaying or preventing dementia. Also, TZD users relative to TZD non-users on dual oral therapy were significantly associated with lower risk of various types of dementia.

Keywords: Alzheimer’s disease, dementia, dipeptidyl-peptidase IV inhibitors, population, type 2 diabetes mellitus, 2, 4-thiazolidinedione

DOI: 10.3233/JAD-201535

Journal: Journal of Alzheimer's Disease, vol. 81, no. 3, pp. 1263-1272, 2021