Summary: Diabetes is among the most common metabolic health disorders, and the number of people living with diabetes is increasing. There are many disorders that are associated with diabetes, including chronic pain, dementia and diabetic neuropathy. Studies also show that those living with diabetes have a significantly higher dementia risk than healthy adults. A new study shows that metformin, a first-line diabetes treatment, may also help significantly reduce dementia risk.
Health experts sometimes call dementia type 3 diabetes for a reason. Unfortunately, though, dementia still remains a poorly understood condition. Nonetheless, it is evident that dementia occurs due to multiple reasons. That is why preventing dementia, and many other neurodegenerative disorders is challenging. It means that the only way to reduce the risk of dementia is through multiple lifestyle measures. For example, reducing exposure to environmental pollutants may help cut down your dementia risk. Similarly, improving metabolic health may also reduce dementia’s risk.
However, many people find it challenging to make significant lifestyle changes. Now a study shows that such people may benefit from metformin treatment. There are multiple reasons why researchers became interested in metformin. First, studies show that those living with diabetes are at a greater risk of developing dementia. Dementia’s incidence in those living with diabetes is almost twice high compared to healthy individuals. This confirms that dementia has something to do with metabolic disorders, too.
Another reason for interest in metformin is how this drug works. Metformin is unique among various medications used to treat diabetes. This is the reason why it has become a first-line treatment for diabetes. Unlike other anti-diabetic drugs, metformin helps reduce insulin resistance. It boosts cellular energy production and prevents mitochondrial dysfunction. It is also suitable for reducing body weight. This is unlike other drugs, for example, sulfonylureas, that increase insulin production.
In recent years, evidence has been accumulating that metformin may help cut down dementia’s risk. Now one of the most extensive observational studies to date shows that the benefit of metformin therapy is massive. It may help reduce dementia risk by almost 20% in those living with diabetes. Of course, 20% may not sound big, but it is worth remembering that there are very few interventions known to reduce dementia’s risk to any significant amount. Thus, these numbers are not as small as they may sound.
In the study, researchers analyzed the data of more than 110,000 adults living with type 2 diabetes. These were adults older than 50 years. Out of them, more than 96,000 were new metformin users, and little more than 16,000 were sulfonylureas users. In the study, they found that while in the metformin group, about 2.3% developed dementia, in the sulfonylurea, about 5.8% developed dementia. Thus, the difference between the two groups was massive. They also analyzed if metformin could help reduce the risk of other common neurodegenerative disorders like Parkinson’s, but they did not find any such association. An almost similar number of individuals were diagnosed with Parkinson’s in the metformin and sulfonylurea groups.
Another interesting finding was that these benefits were more pronounced in those younger than 75. It means that in very old adults, metformin has a lesser advantage. This is expected, as mitochondrial dysfunction is more difficult to prevent or reverse in older adults.The study has some limitations, like it did not consider other lifestyle or confounding factors.
Nonetheless, the study opens doors for further investigations. For example, it is now essential to understand if metformin can also help reduce dementia risk in non-diabetic people.
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By Gurpreet Singh Padda, MD, MBA, MHP