Association between SGLT2 inhibitor therapy and prolonged dementia-free survival in older adults with type 2 diabetes: a retrospective cohort study from Germany.

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of dementia due to hyperglycemia, insulin resistance, and vascular dysfunction. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) may have neuroprotective effects beyond glucose control, but evidence remains limited. This study aimed to assess whether SGLT2i use is associated with a lower incidence of dementia compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) in older adults with T2DM.

METHODS

This retrospective cohort study used data from the IQVIA™ Disease Analyzer database in Germany. Patients aged ≥60 years with T2DM, receiving metformin and newly prescribed SGLT2i or DPP-4i (2012-2022), were included. Those with prior neurodegenerative diagnoses were excluded. Propensity score matching (1:1) and Cox proportional hazards models were used to estimate hazard ratios (HR) for dementia over five years.

RESULTS

After matching, 38,140 patients were included. Dementia incidence was lower in the SGLT2i group (5.4 %) than the DPP-4i group (6.4 %) (p = 0.002). SGLT2i use was linked to a 20 % reduced dementia risk (HR: 0.80; 95 % CI: 0.70-0.93; p = 0.002), especially in patients >80 years (HR: 0.75) and males (HR: 0.77).

CONCLUSIONS

SGLT2i therapy was associated with a lower incidence of dementia in older adults with T2DM, particularly in men and the very elderly.