Closeup of man getting ready to take a pill with water

For the most part, oral anti-diabetic (OAD) medications can help slow cognitive decline and reduce the risk and incidence of dementia as a complication of type 2 diabetes, a new report has found.

The findings are important, as people with type 2 diabetes have a higher risk for developing dementia. The authors said their results give more insight into the role of anti-diabetic medication as a potential preventative tool. The report was published Monday in Cureus

OADs include metformin, sulfonylurea (SU), thiazolidinediones (TZD), dipeptidyl peptidase-4 (DPP-4i), GLP-1 receptor agonists, sodium-glucose cotransporter 2 (SGLT-2), meglitinides and alpha-glucosidase inhibitors (aGI). Metformin is the most prescribed OAD, the authors noted. 

Researchers looked at 52 existing studies on OAD and dementia as part of their meta-analysis.

OADs except sulfonylureas (SU) significantly slowed the decline of cognitive function and lowered the risk incidence of dementia. SUs raised the risk of dementia in most of the existing research the scientists reviewed.

A lot of the studies that the team reviewed showed that most anti-diabetic drugs significantly reduced the risk and incidence of dementia in people who had type 2 diabetes. Pioglitazone, a TZD, seemed to work best at reducing the risk and incidence of dementia, especially when people took it along with metformin.

“TZD specifically showed the greatest reduction, however, in the risk and incidence of dementia, pioglitazone, which can cross the blood-brain barrier and is dose-dependent,” the authors wrote. “It’s important to note that the results concerning second-line antidiabetics involved concurrent use of metformin and other second-line antidiabetics.”

The authors noted that insulin has been shown to raise the risk and incidence of dementia. The researchers said they weren’t sure if that was because of the advanced stage of diabetes in people who were prescribed insulin.

A 2021 report found that the odds of older adults with cognitive impairment developing dementia triples when diabetes is poorly controlled. The authors of that study said diabetes itself is not a factor in how dementia progresses.