Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Diabetes Obes Metab. 2024 Feb;26(2):441-462. doi: 10.1111/dom.15331. Epub 2023 Oct 23.
The objective of this umbrella review and meta-analysis was to evaluate the effect of diabetes on risk of dementia, as well as the mitigating effect of antidiabetic treatments.
We conducted a systematic umbrella review on diabetes and its treatment, and a meta-analysis focusing on treatment. We searched MEDLINE/PubMed, Embase, PsycINFO, CINAHL and the Cochrane Library for systematic reviews and meta-analyses assessing the risk of cognitive decline/dementia in individuals with diabetes until 2 July 2023. We conducted random-effects meta-analyses to obtain risk ratios and 95% confidence intervals estimating the association of metformin, thiazolidinediones, pioglitazone, dipeptidyl peptidase-4 inhibitors, α-glucosidase inhibitors, meglitinides, insulin, sulphonylureas, glucagon-like peptide-1 receptor agonists (GLP1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) with risk of dementia from cohort/case-control studies. The subgroups analysed included country and world region. Risk of bias was assessed with the AMSTAR tool and Newcastle-Ottawa Scale.
We included 100 reviews and 27 cohort/case-control studies (N = 3 046 661). Metformin, thiazolidinediones, pioglitazone, GLP1RAs and SGLT2is were associated with significant reduction in risk of dementia. When studies examining metformin were divided by country, the only significant effect was for the United States. Moreover, the effect of metformin was significant in Western but not Eastern populations. No significant effect was observed for dipeptidyl peptidase-4 inhibitors, α-glucosidase inhibitors, or insulin, while meglitinides and sulphonylureas were associated with increased risk.
Metformin, thiazolidinediones, pioglitazone, GLP1RAs and SGLT2is were associated with reduced risk of dementia. More longitudinal studies aimed at determining their relative benefit in different populations should be conducted.
本综述和荟萃分析旨在评估糖尿病对痴呆风险的影响，以及抗糖尿病治疗的缓解作用。
我们对糖尿病及其治疗进行了系统的综述，并进行了一项侧重于治疗的荟萃分析。我们检索了 MEDLINE/PubMed、Embase、PsycINFO、CINAHL 和 Cochrane 图书馆，以获取截至 2023 年 7 月 2 日评估糖尿病个体认知能力下降/痴呆风险的系统评价和荟萃分析。我们进行了随机效应荟萃分析，以获得风险比和 95%置信区间，估计二甲双胍、噻唑烷二酮、吡格列酮、二肽基肽酶-4 抑制剂、α-葡萄糖苷酶抑制剂、米格列奈、胰岛素、磺酰脲类、胰高血糖素样肽-1 受体激动剂 (GLP1RA) 和钠-葡萄糖协同转运蛋白-2 抑制剂 (SGLT2i) 与来自队列/病例对照研究的痴呆风险的关联。分析的亚组包括国家和世界区域。使用 AMSTAR 工具和纽卡斯尔-渥太华量表评估偏倚风险。
我们纳入了 100 篇综述和 27 项队列/病例对照研究（N=3046611）。二甲双胍、噻唑烷二酮、吡格列酮、GLP1RA 和 SGLT2i 与痴呆风险降低显著相关。当按国家对研究二甲双胍进行分类时，只有美国的效果显著。此外，二甲双胍在西方国家人群中的效果显著，但在东方人群中则不显著。二肽基肽酶-4 抑制剂、α-葡萄糖苷酶抑制剂或胰岛素没有显著效果，而米格列奈和磺酰脲类则与风险增加相关。
二甲双胍、噻唑烷二酮、吡格列酮、GLP1RA 和 SGLT2i 与痴呆风险降低相关。应该进行更多的旨在确定它们在不同人群中的相对益处的纵向研究。
