Abstract Details

Title Metformin and Newer Oral Hypoglycemic Agents are Associated with Better Cognitive Test Performance Over Ten Years in Older Diabetic Men

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-010

Objective To determine if choice of single hypoglycemic agent predicted ten-year cognitive trajectory in diabetic older men.

Background

It is well established that type 2 diabetes is a risk factor for cognitive decline and dementia. Recent studies suggest that hypoglycemic agents in the biguanide and sulfonylurea classes may slow or prevent cognitive decline in individuals with diabetes, though community-based studies of these and newer oral agents are lacking.

Design/Methods

We prospectively studied 442 community-dwelling men (mean age 75.3 years) who were single-agent users of metformin, a sulfonylurea, or other oral hypoglycemic (α-glucosidase inhibitor, DPP-4 inhibitor, SGLT2 inhibitor, meglitinide, thiazolidinedione, or GLP-1 agonist), excluding those with severe renal disease, liver disease, or dementia. Ten-year changes in Modified Mini-Mental State Examination (3MS) and Trails B performance were examined with mixed effects models adjusting for age, race, education, body mass index, renal function and hypertension.

Results Of the 442 participants, 174(39.4%) used metformin, 223(50.5%) a sulfonylurea, and 45(10.2%) another oral agent. At baseline, sulfonylurea users had a worse Trails B score (completion time) than metformin users (+15.62 sec, p=0.006) and newer oral agent users (+21.32 sec, p=0.035). Over ten years of follow-up, newer oral agent users had less decline compared to sulfonylurea users on both the 3MS (mean difference +5.54 points, p=0.017) and Trails B (+28.47 sec, p=0.012). Metformin users similarly showed less decline compared to sulfonylurea users on the Trails B (+22.84 sec, p=0.043).

Conclusions

After accounting for known confounders, older diabetic men using metformin or newer hypoglycemic agents exhibited less cognitive compared to those taking sulfonylureas. These findings support the possible protective effects of metformin and suggest that newer oral agents may present new opportunities for further research and therapeutic strategies in the prevention of cognitive decline among older adults with diabetes.

Authors/Disclosures
Siena Duarte, MD, MAS (Johns Hopkins Medical Institute) PRESENTER	Dr. Duarte has received personal compensation for serving as an employee of Johns Hopkins University. Dr. Duarte has received personal compensation for serving as an employee of University of California, San Francisco.
	No disclosure on file
	No disclosure on file
Kristine Yaffe, MD	Dr. Yaffe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lilly. Dr. Yaffe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Quintiles. Dr. Yaffe has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Alector. The institution of Dr. Yaffe has received research support from NIH. The institution of Dr. Yaffe has received research support from DOD. The institution of Dr. Yaffe has received research support from Veterans Affairs.

��ɫ��

��ɫ��