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Metformin Linked to Reduced Cognitive Decline, Dementia Risk

Older people taking metformin, the first-line treatment for type 2 diabetes, show significantly lower rates of dementia and cognitive decline compared to those with diabetes not receiving the drug, with the former having dementia rates that are, in fact, similar to people without diabetes, new research shows.

“After controlling for dementia risk factors that might promote cognitive aging, metformin appeared to mitigate the effect of diabetes on cognitive decline in older people,” first author Katherine Samaras, MBBS, PhD, told Medscape Medical News.

The findings are notable considering the increased risk of cognitive decline that is associated with diabetes, said Samaras, leader of the Healthy Ageing Research Theme at the Garvan Institute and an endocrinologist at St Vincent’s Hospital, Sydney, Australia.

“As they age, people living with type 2 diabetes have a staggering 60% risk of developing dementia, a devastating condition that impacts thinking, behavior, the ability to perform everyday tasks, and the ability to maintain independence,” she said in a press release issued by her institute.

And the results are particularly remarkable in that “few prior studies have controlled for multiple dementia risk factors, including the dementia susceptibility gene APOE4,” Samaras emphasized. 

As the front-line drug treatment for type 2 diabetes, metformin has been extensively studied and, with some other research also showing cognitive benefits, “these results are not surprising,” Mark E. Molitch, MD, told Medscape Medical News.

Nevertheless, “this reinforces the idea that metformin should be the first drug used to treat diabetes, and it should be continued if other drugs are added for blood glucose control,” said Molitch, of the Division of Endocrinology, Metabolism & Molecular Medicine, at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Significant Differences in Global Cognition, Executive Function 

In the observational, prospective study, published online in Diabetes Care, Samaras and colleagues identified 1037 community-dwelling people without dementia between the ages of 70 and 90 who were enrolled in the Sydney Memory and Ageing Study in Australia.

Among the participants, 123 (12%) had type 2 diabetes, including 67 who were treated with metformin; 34 as a single medication and 33 in combination with other medications, most commonly sulfonylureas (70%).

Of the 56 patients with diabetes who did not receive metformin, 34 were treated with diet alone, while the remainder were treated with other glucose-lowering medications.

There were no significant baseline differences between the groups in cognitive performance at baseline, after a multivariate adjustment. Their mean age was about 79.

All participants received neuropsychological testing for cognitive function every 2 years, including memory, executive function, attention, speed, and language tests.

In terms of cognitive decline over the 6 years, those treated with metformin had a significantly lower decline in global cognition compared to those with diabetes not taking metformin (P = .032), and the rate of decline of metformin-treated participants was not different compared to those without diabetes.

There was also a slower decline in executive function in those treated versus not treated with metformin (P =

Improving blood sugar in Type 2 diabetes improves cognitive scores, study says

Oct. 5 (UPI) — Controlling blood sugar levels helped people with Type 2 diabetes who were overweight improve cognitive scores, but losing weight, exercise had mixed results, a new study shows.

More than a quarter of U.S. adults 65 or older have Type 2 diabetes, which doubles the risk of cognitive impairment and dementia, including Alzheimer’s disease, according to a statement from the Pennington Biomedical Research Center.

“It’s important to properly control your blood sugar to avoid the bad brain effects of your diabetes,” said study author Owen Carmichael said in a statement.

“Don’t think you can simply let yourself get all the way to the obese range, lose some of the weight, and everything in the brain is fine,” said Carmichael, a professor and director of Biomedical Imaging at Pennington Biomedical Research Center. “The brain might have already turned a corner that it can’t turn back from.”

The study, published in the latest issue of The Journal of Clinical Endrocrinology and Metabolism, analyzed whether markers such as body weight, blood sugar control, and physical activity would be associated with improved cognition in 1,089 participants, age 45 to 76, who have Type 2 diabetes.

Researchers theorized that greater improvements in all three markers would lead to better cognitive test scores, but that turned out to be only partially true. While reducing blood sugar levels improved test scores, losing more weight and exercising more didn’t always do so.

“Every little improvement in blood sugar control was associated with a little better cognition,” Carmichael said. “Lowering your blood sugar from the diabetes range to prediabetes helped as much as dropping from prediabetes levels to the healthy range.”

Meanwhile, results from weight loss varied depending on the mental skill, according to Carmichael. More weight loss improved participants short-term memory, planning, impulse control, attention and the ability to switch tasks, but verbal learning and overall memory still declined.

“The results were worse for people who had obesity at the beginning of the study,” he added.

Similarly, Carmichael said the study showed that increasing physical activity also benefited people who were overweight more than people with obesity.

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