Huang Kuang-Hua, Tsai Ya-Fang, Lee Chiachi Bonnie, Gau Shuo-Yan, Tsai Tung-Han, Chung Ning-Jen, Lee Chien-Ying
Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan.
Department of Health Policy and Management, Chung Shan Medical University, Taichung 40201, Taiwan.
J Pers Med. 2023 Apr 26;13(5):738. doi: 10.3390/jpm13050738.
The evidence of metformin's effect on dementia is conflicting. This study investigates the association between metformin use and the risk of dementia among patients with diabetes mellitus (DM). This study included patients with new-onset DM between 2002 and 2013. We divided the patients into patients who used metformin and patients who did not. Two models were used to assess metformin use: the cumulative defined daily dose (cDDD) of metformin use and the intensity of metformin use. This study with 3-year and 5-year follow-ups investigated the risk of dementia among patients with DM who used metformin. At the 3-year follow-up, patients who received cDDD < 300 had an odds ratio (OR) of developing dementia of 0.92 (95% confidence interval [CI] = 0.89-0.96); patients who used metformin at intensities <10 and 10-25 DDD/month had ORs of 0.92 (95% CI: 0.87-0.97) and 0.92 (95% CI: 0.85-1.00), respectively. Metformin use at cDDD 300-500 (OR = 0.80, 95% CI = 0.56-1.15) or >500 (OR = 1.48, 95% CI = 0.48-4.60) or at an intensity >25 DDD/month (OR = 0.84, 95% CI = 0.60-1.18) were not associated with an incident of dementia. There were similar results at the 5-year follow-up. Patients with a low intensity of metformin use had a lower risk of dementia. However, higher doses of metformin with higher intensity exhibited no protective role in dementia. Prospective clinical trials are warranted to evaluate the actual underlying mechanisms between metformin dosage and the risk of dementia.
二甲双胍对痴呆症影响的证据相互矛盾。本研究调查了糖尿病（DM）患者使用二甲双胍与患痴呆症风险之间的关联。本研究纳入了2002年至2013年间新诊断为DM的患者。我们将患者分为使用二甲双胍的患者和未使用二甲双胍的患者。使用两种模型评估二甲双胍的使用情况：二甲双胍使用的累积限定日剂量（cDDD）和二甲双胍使用强度。本研究进行了3年和5年的随访，调查了使用二甲双胍的DM患者患痴呆症的风险。在3年随访时，cDDD＜300的患者患痴呆症的比值比（OR）为0.92（95%置信区间[CI]=0.89 - 0.96）；使用二甲双胍强度＜10 DDD/月和10 - 25 DDD/月的患者OR分别为0.92（95% CI：0.87 - 0.97）和0.92（95% CI：0.85 - 1.00）。cDDD为300 - 500（OR = 0.80，95% CI = 0.56 - 1.15）或＞500（OR = 1.48，95% CI = 0.48 - 4.60）或强度＞25 DDD/月（OR = 0.84，95% CI = 0.60 - 1.18）的二甲双胍使用与痴呆症发病无关。5年随访时有类似结果。二甲双胍使用强度低的患者患痴呆症风险较低。然而，更高剂量和更高强度的二甲双胍在痴呆症方面未表现出保护作用。有必要进行前瞻性临床试验来评估二甲双胍剂量与痴呆症风险之间实际的潜在机制。
