Tang Chunbian, Hao Jiayi, Tao Fengran, Feng Qingguo, Song Ying, Zeng Baoqi
Medical School of Tianjin University, Tianjin, China.
Department of General Medicine, Peking University Binhai Hospital (Tianjin Fifth Central Hospital), Tianjin, China.
Diabetes Obes Metab. 2025 Apr;27(4):1992-2001. doi: 10.1111/dom.16192. Epub 2025 Jan 8.
There is ongoing debate concerning the association of metformin with the risk of dementia in type 2 diabetes mellitus (T2DM). This study was conducted to evaluate the impact of metformin therapy on dementia in patients with T2DM.
PubMed, Embase, Cochrane Library, Web of Science and the ClinicalTrials.gov website were searched until 9 April 2024. Cohort studies investigating the effects of metformin therapy compared with other antidiabetic drugs or no therapy in T2DM were included. The hazard ratio (HR) and the 95% confidence interval (CI) were computed using the random effects model.
Twenty cohort studies (24 individual comparisons) involving 3 463 100 participants were identified. A meta-analysis revealed that people with T2DM who take metformin are linked to a lower incidence of all-cause dementia compared to non-user (n = 17, HR = 0.76, 95% CI = 0.65-0.91, p = 0.002, I = 98.9%) and sulfonylureas (n = 5, HR = 0.88, 95% CI = 0.85-0.90, p < 0.001, I = 9.7%), but not to thiazolidinedione (n = 2, HR = 0.53, 95% CI = 0.08-3.41, p = 0.503, I = 92.7%). Additionally, metformin showed favourable effects in non-specified T2DM (n = 19, HR = 0.75, 95% CI = 0.64-0.89), but not in newly diagnosed T2DM (n = 5, HR = 1.01, 95% CI = 0.81-1.27).
Metformin might correlate with a lower dementia incidence in people with T2DM. However, it is crucial to interpret these results with caution considering the high heterogeneity.
关于二甲双胍与2型糖尿病（T2DM）患者痴呆风险之间的关联，目前仍存在争议。本研究旨在评估二甲双胍治疗对T2DM患者痴呆的影响。
检索了PubMed、Embase、Cochrane图书馆、Web of Science和ClinicalTrials.gov网站，直至2024年4月9日。纳入了比较二甲双胍治疗与其他抗糖尿病药物或不治疗对T2DM患者影响的队列研究。采用随机效应模型计算风险比（HR）和95%置信区间（CI）。
共纳入20项队列研究（24项个体比较），涉及3463100名参与者。一项荟萃分析显示，与未使用二甲双胍的T2DM患者（n = 17，HR = 0.76，95% CI = 0.65 - 0.91，p = 0.002，I = 98.9%）和使用磺脲类药物的患者（n = 5，HR = 0.88，95% CI = 0.85 - 0.90，p < 0.001，I = 9.7%）相比，使用二甲双胍的T2DM患者全因痴呆发病率较低，但与噻唑烷二酮类药物使用者（n = 2，HR = 0.53，95% CI = 0.08 - 3.41，p = 0.503，I = 92.7%）相比无差异。此外，二甲双胍在未明确的T2DM患者中显示出有益效果（n = 19，HR = 0.75，95% CI = 0.64 - 0.89），但在新诊断的T2DM患者中未显示出有益效果（n = 5，HR = 1.01，95% CI = 0.81 - 1.27）。
二甲双胍可能与T2DM患者较低的痴呆发病率相关。然而，考虑到高度异质性，谨慎解读这些结果至关重要。
