Association of sodium-glucose cotransporter 2 inhibitors with time to dementia: a population-based cohort study.
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Abstract
OBJECTIVE: Type 2 diabetes (T2D) increases dementia risk, but clear evidence to recommend interventions that can mitigate that risk remains lacking. This population-based retrospective cohort study aimed to determine whether new use of sodium–glucose cotransporter 2 (SGLT2) inhibitors compared with dipeptidyl peptidase 4 (DPP-4) inhibitors was associated with lower dementia risk. RESEARCH DESIGN AND METHODS: Ontario residents aged ≥66 years who were new users of an SGLT2 inhibitor or a DPP-4 inhibitor from 1 July 2016 to 31 March 2021 entered the cohort. Incident dementia was identified using a validated algorithm for Alzheimer’s disease and related dementias. Propensity score–weighted Cox proportional hazards models were used to obtain adjusted hazard ratios (aHR) and CIs for time to incident dementia. To address reverse causality and disease latency, the observation window started at 1-year lag time from cohort entry. The primary analysis followed intention-to-treat exposure definition, and a secondary as-treated analysis was performed. RESULTS: Among 106,903 individuals, SGLT2 inhibitors compared with DPP-4 inhibitors were associated with lower risk of dementia (14.2/1,000 person-years; aHR 0.80 [95% CI 0.71–0.89]) over a mean follow-up of 2.80 years from cohort entry. When stratified by different SGLT2 inhibitors, dapagliflozin exhibited the lowest risk (aHR 0.67 [95% CI 0.53–0.84]), followed by empagliflozin (aHR 0.78 [95% CI 0.69–0.89]), whereas canagliflozin showed no association (aHR 0.96 [95% CI 0.80–1.16]). The as-treated analysis observed a larger association (aHR 0.66 [95% CI 0.57–0.76]) than the intention-to-treat analysis. CONCLUSIONS: SGLT2 inhibitors showed an association with lower dementia risk in older people with T2D. Randomized controlled trials are warranted.
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Observational evidence suggests that certain glucose-lowering drug classes, such as SGLT2is and GLP-1RAs, may have a neuroprotective effect.
“Observational evidence suggests that certain glucose-lowering drug classes, such as SGLT2is and GLP-1RAs, may have a neuroprotective effect.8,9”
From Cardioprotective Glucose-Lowering Agents and Dementia Risk: A Systematic Review and Meta-Analysis (2025) · cites this paper as [9]
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- Authors
- Wu, C.-Y., Iskander, C., Wang, C., Xiong, L. Y., Shah, B. R., Edwards, J. D., Kapral, M. K., Herrmann, N., Lanctôt, K. L., Masellis, M., Swartz, R. H., Cogo-Moreira, H., MacIntosh, B. J., Rabin, J. S., Black, S. E., Saskin, R., & Swardfager, W.
- Affiliations
- University of Toronto (CA)
- Institute for Clinical Evaluative Sciences (CA)
- Sunnybrook Health Science Centre (CA)
- University of Ottawa (CA)
- 2Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Oslo University Hospital (NO)
- University Health Network (CA)
- Corresponding author
- Swardfager, Walter
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-12-12
- Volume
- 46
- Issue
- 2
- Pages
- 297-304
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W4311187428
- Cited by
- 139
- References
- 37
- Citations by year
- 2026: 20 · 2025: 57 · 2024: 39 · 2023: 23
- FWCI
- 22.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Michael J. Fox Foundation for Parkinson’s Research (BAND3)
- Fondation Brain Canada (AARG501466)
- Canada Research Chairs
- Canadian Network for Research and Innovation in Machining Technology, Natural Sciences and Engineering Research Council of Canada (RGPIN-2017-06962)
- Alzheimer’s Research Trust (BAND3)
- Canadian Institutes of Health Research (202111FBD-476273-75801, PJT-159711)
- Alzheimer’s Association (AARG501466, BAND3)
- Weston Brain Institute (BAND3)
- Banting and Best Diabetes Centre, University of Toronto (Tamarack Graduate Award in Diabetes Research)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- SGLT2 inhibitors, dementia risk, type 2 diabetes, DPP-4 inhibitors, dapagliflozin, empagliflozin, canagliflozin, Alzheimer's disease, older adults, as-treated analysis, intention-to-treat analysis
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Aged, Alzheimer Disease, Diabetes Mellitus, Type 2, Glucose, Humans, Hypoglycemic Agents, Retrospective Studies, Sodium, Cohort Studies, Sodium-Glucose Transporter 2, Dipeptidyl-Peptidase IV Inhibitors
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