Abdullah Zarin, Cui Ying, Platt Robert W, Renoux Christel, Azoulay Laurent, Xia Chenjie, Yu Oriana Hoi Yun
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada.
Lady Davis Institute for Medical Research Centre for Clinical Epidemiology, Montreal, Québec, Canada.
BMJ Open Diabetes Res Care. 2025 Jan 21;13(1):e004541. doi: 10.1136/bmjdrc-2024-004541.
To assess the association between sodium-glucose co-transporter-2 inhibitor (SGLT-2i) use and the risk of incident dementia compared with dipeptidyl peptidase-4 inhibitors (DPP-4i) use among individuals with type 2 diabetes.
A population-based retrospective cohort study.
The Clinical Practice Research Datalink (CPRD) Aurum database from the UK.
Individuals with type 2 diabetes, aged 40 years or older, newly prescribed SGLT-2i or DPP-4i on or after 2013-2021, registered in the CPRD Aurum database.
The primary outcome was incident dementia, and the secondary outcome was incident mild cognitive impairment (MCI). Cox proportional hazard models were used to estimate the HR and corresponding 95% CI for the primary and secondary outcomes. Propensity score fine stratification weights were used to adjust for confounding.
Among a cohort of 118 006 individuals, the incident rate (IR) of dementia was 0.56/1000 person-years over a median follow-up period of 1.54 years among SGLT-2i users compared with 2.67/1000 person-years in DPP-4i users, over a median follow-up period of 1.79 years. The adjusted HR for SGLT-2i use compared with DPP-4i use for dementia was 0.78 (95% CI 0.55 to 1.12), while for MCI was 0.86 (95% CI 0.80 to 0.92). The age-specific stratified analysis demonstrated the adjusted HR for SGLT-2i use compared with DPP-4i use for the risk of incident dementia among elderly, aged ≥65 years, was 0.50 (95% CI 0.31 to 0.80).
Primary findings did not yield conclusive evidence to infer an association between SGLT-2i use and the risk of incident dementia.
评估2型糖尿病患者中，与使用二肽基肽酶-4抑制剂（DPP-4i）相比，使用钠-葡萄糖协同转运蛋白-2抑制剂（SGLT-2i）与新发痴呆风险之间的关联。
一项基于人群的回顾性队列研究。
来自英国的临床实践研究数据链（CPRD）Aurum数据库。
年龄在40岁及以上、于2013年至2021年期间或之后新开具SGLT-2i或DPP-4i处方、并在CPRD Aurum数据库中注册的2型糖尿病患者。
主要结局为新发痴呆，次要结局为新发轻度认知障碍（MCI）。采用Cox比例风险模型估计主要和次要结局的风险比（HR）及相应的95%置信区间（CI）。使用倾向评分精细分层权重来调整混杂因素。
在118006名队列参与者中，SGLT-2i使用者在中位随访期1.54年期间的痴呆发病率（IR）为0.56/1000人年，而DPP-4i使用者在中位随访期1.79年期间的痴呆发病率为2.67/1000人年。与使用DPP-4i相比，使用SGLT-2i发生痴呆的校正HR为0.78（95%CI 0.55至1.12），而发生MCI的校正HR为0.86（95%CI 0.80至0.92）。年龄特异性分层分析表明，在≥65岁的老年人中，与使用DPP-4i相比，使用SGLT-2i发生新发痴呆风险的校正HR为0.50（95%CI 0.31至0.80）。
主要研究结果未得出确凿证据来推断使用SGLT-2i与新发痴呆风险之间存在关联。
