Chen Po-Chih, Hong Chien-Tai, Chen Wan-Ting, Chan Lung, Chien Li-Nien
Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei City, Taiwan.
Endocr Pract. 2023 Apr;29(4):247-253. doi: 10.1016/j.eprac.2023.01.007. Epub 2023 Jan 16.
Metformin is widely used as the first-line drug for type 2 diabetes mellitus and has numerous benefits apart from lowering blood glucose. However, metformin-retained regimen is challenged by newly launching, powerful glucose-lowering antiglycemic agents. This population-based cohort study examined the association between metformin adherence and the risk of dementia and Parkinson's disease (PD).
Diabetic patients with metformin-included combination antiglycemic therapy were identified from the National Health Insurance Research Database and categorized into metformin-adherent and -nonadherent groups according to the medical record of the first year prescription. Patients contraindicated with metformin, severe diabetic complications, and poor drug compliance were excluded. The study outcome was the diagnosis of dementia or PD.
A total of 31 384 matched pairs were included after using propensity score matching and both groups were followed up for an average of 5 years. Metformin adherence was associated with a significantly lower risk of dementia (adjusted hazard risk ratio = 0.72, P < .001) but not PD (adjusted hazard risk ratio = 0.97, P = .825). Subgroup analysis revealed that the risk of dementia was significantly reduced in metformin-adherent patients, both male and female, aged >65 or ≤ 65 years, and with or without concurrent insulin treatment. This effect was not influenced by concurrent insulin treatment, which may eliminate the bias caused by the severity of diabetes mellitus.
Despite the launching of numerous new oral antiglycemic agents, metformin may provide further benefit on lowering risk of dementia beyond conventional glycemic control according to the real-world evidence.
二甲双胍被广泛用作2型糖尿病的一线药物，除了降低血糖外还有诸多益处。然而，二甲双胍维持治疗方案受到新推出的强效降糖抗糖尿病药物的挑战。这项基于人群的队列研究探讨了二甲双胍依从性与痴呆症和帕金森病（PD）风险之间的关联。
从国民健康保险研究数据库中识别出接受含二甲双胍联合抗糖尿病治疗的糖尿病患者，并根据第一年处方的病历将其分为二甲双胍依从组和非依从组。排除二甲双胍禁忌、严重糖尿病并发症和药物依从性差的患者。研究结局为痴呆症或PD的诊断。
在使用倾向评分匹配后，共纳入31384对匹配对，两组平均随访5年。二甲双胍依从性与痴呆症风险显著降低相关（调整后的风险比=0.72，P<.001），但与PD无关（调整后的风险比=0.97，P=.825）。亚组分析显示，二甲双胍依从性患者无论男女，年龄>65岁或≤65岁，无论是否同时接受胰岛素治疗，痴呆症风险均显著降低。这种效应不受同时接受胰岛素治疗的影响，这可能消除了由糖尿病严重程度引起的偏差。
尽管有多种新型口服抗糖尿病药物推出，但根据真实世界证据，二甲双胍除了常规血糖控制外，可能在降低痴呆症风险方面提供进一步益处。
