"The groundwork of all happiness is health." - Leigh Hunt

Can diabetes medications reduce the chance of age-related dementia?

November 6, 2023 – It's latest, it's exciting, and it's a subject that has many diabetes researchers and doctors cautiously optimistic, while others are waiting until more evidence emerges.

But for older individuals with type 2 diabetes, in addition to those starting treatment, the news could possibly be a transparent win: New research has shown that common diabetes medications can reduce the chance of dementia and possibly other potentially life-threatening diseases Disturbances.

If this connection is proven, it could literally open a path to mindful aging.

Diabetes affects roughly 37 million people within the USA and almost half a billion people worldwide, numbers which are expected to extend significantly over the subsequent twenty years. At the identical time, “approximately 47 million people are living with dementia, and we expect that number to nearly double in 2030 and again in 2050,” said Stella Daskalopoulou, MD, a professor and internist within the university's department of medication McGill University Health Center in Montreal.

The two diseases are linked, and there’s a growing body of research suggesting that diabetes can be present Metabolic syndrome and obesity increase the chance of dementia. This raises the query of whether higher control of diabetes and related diseases might help preserve mental abilities throughout life.

“There has been a lot of work over the last decade to use existing data to understand the association between different diabetes medications and the risk of mild cognitive impairment or dementia,” said Rozalina G. McCoy, MD, associate professor of medication and associate department head for clinical research within the Department of Endocrinology, Diabetes and Nutrition on the University of Maryland School of Medicine in Baltimore.

“They’ve been really consistent with what they’ve found,” she said. They found that continued use of metformin, a quite common medication used to treat blood sugar problems in individuals with diabetes, appears to cut back the chance of cognitive impairment or dementia. On the opposite hand, one other diabetes drug called sulfonylureas is related to a better risk.

A recent review and evaluation co-authored by Daskalopoulou seems to substantiate this this protection Effect of metformin against cognitive decline. But metformin isn't the one drug that appears to support the brain; The researchers learned that studies of newer drugs similar to Jardiance, Ozempic and Trulicity also appear to significantly reduce the chance of dementia, even perhaps greater than metformin.

Importantly, there are not any studies comparing metformin to those newer agents, making it not possible to attract definitive conclusions, but the information looks promising.

Even more convincing is a Recent study It analyzed data from the health records of over 40,000 individuals with type 2 diabetes who either routinely took metformin or stopped taking their medication for various reasons but continued to take at the very least one other diabetes medication.

“We found that maintaining metformin prevents or delays the onset of dementia,” said senior writer Sarah Ackley, PhD, an epidemiologist at Boston University, and first writer Scott C. Zimmerman, MPH, a research data analyst within the Boston University Department of Epidemiology and Biostatistics, University of California San Francisco.

On the opposite hand, the dementia rate gave the impression to be 1.2 times higher in individuals who stopped metformin, again suggesting the protective effect of metformin.

“Because both starting and continuing treatment with metformin appears to be beneficial, it is likely that any exposure – even limited exposure – to metformin is beneficial,” they said.

But Absalon Gutierrez, MD, associate professor at McGovern Medical School on the University of Texas Health Science Center at Houston and medical director of endocrinology at Lyndon B. Johnson Hospital, said these studies have a crucial caveat:

The study doesn’t prove that metformin reduces the chance of dementia. In other words, he said, “It can't establish causality.” There could have been other aspects that led to dementia. Larger, high-quality studies are needed.”

Diabetes and the brain

It appears that quite a few things have a connection between diabetes and brain health. Arman Fesharaki-Zadeh, MD, PhD, behavioral neurologist and neuropsychiatrist at Yale School of Medicine in New Haven, CT, said magnetic resonance imaging (MRI) of patients with uncontrolled diabetes shows blood vessel changes which have a serious impact on how the body delivers oxygen .

“It is essentially vascular damage to the brain that occurs over time, usually due to diabetes, high blood pressure and high cholesterol (i.e. metabolic syndrome),” he said. “And studies show that the rate of this progression tends to be significantly faster in diabetics with Alzheimer’s.”

Another vital key’s blood sugar or glucose, a primary energy source for the brain.

“If you have a condition that fundamentally alters the way your body processes blood sugar, that can significantly impact your cognition by proxy,” Fesharaki-Zadeh said.

But “if someone is already in the process of developing full-blown vascular dementia or Alzheimer's disease or a combination, tight control of their diabetes can slow that decline,” he said.

The path to higher cognition begins with higher health

Research has yet to point out whether certain diabetes medications are higher than others at slowing the progression of mental disability, dementia and/or Alzheimer's disease. What is evident, nevertheless, is that higher diabetes control results in quite a lot of higher health outcomes.

McCoy points out several vital things to remember when talking to your doctor about diabetes, whether you're newly diagnosed or a veteran.

“Most of my patients consult me ​​about lowering their blood sugar levels, but lowering blood sugar is not the only consideration,” she said. Doctors also must take into consideration general health and possibly cardiac results; for instance, which drug reduces the chance of a heart attack or stroke, fatty liver disease, cancer or dementia. They also need to contemplate “how difficult it will be for them to take this medication and what impact this medication will have on their life.”

“I usually start with metformin because there is overwhelming evidence that it is fundamentally beneficial not only for diabetes but also for heart attacks and strokes and microvascular diseases such as retinopathy or neuropathy,” Daskalopoulou said.

Still, like other diabetes medications, metformin is just not without unwanted side effects, and he or she said she sees them steadily.

“Sometimes you have to reduce [dosage] because they have a lot of gastrointestinal side effects like diarrhea or nausea, and then you have to add another agent to compensate,” she explained.

Sometimes, Daskalopoulou says, if a patient can't tolerate metformin, one other drug might work higher.

At the identical time, none of those medications are the be-all and end-all and so they needs to be viewed as supplements relatively than replacements for lifestyle changes.

In addition to weight reduction and food plan, Fesharaki-Zadeh mentioned a crucial intervention that not only helps improve diabetes outcomes and, ideally, reverse diabetes progression, but in addition has a big impact on brain health: exercise.

“I cannot emphasize enough the importance of exercise. Having a healthy cardiovascular system, especially through training your muscles, can go a long way in controlling the way your body processes blood sugar levels. But there is also a phenomenon that occurs in the brains of people who exercise called neurogenesis; They are literally forming new connections in the memory regions of their brain.”

“Why wait until the crisis is already underway?” he said.