A recent study published in eClinical Medicine compares the effectiveness of anti-diabetes medications in reducing the risk of dementia in older diabetics. Study: Comparative effectiveness of glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, and sulfonylureas on the risk of dementia in older individuals with type 2 diabetes in Sweden: an emulated trial study. Image Credit: WR7 / Shutterstock.
com The most common second-line anti-diabetes medications include sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide 1 (GLP-1) agonists. Among these medications, sulfonylureas are the oldest and most widely used; however, both DPP-4 inhibitors and GLP-1 agonists are also being increasingly prescribed. Sulfonylureas directly stimulate insulin secretion irrespective of blood sugar levels.
GLP-1 is an incretin, which is a hormone released in response to food intake that increases insulin release. GLP-1 receptor activation by GLP-1 or a GLP-1 agonist promotes insulin secretion, reduces glucagon secretion, and causes delayed gastric emptying and, subsequently, a feeling of fullness. DPP-4 inhibitors maintain higher GLP-1 levels for longer periods by suppressing its breakdown by DPP-4.
Previous randomized controlled trials (RCTs) have demonstrated that GLP-1 agonists are more protective against cognitive impairment and dementia than placebo. However, these RCTs were relatively small, and there is little real-world evidence to support these obs.
