Pioglitazone may protect against dementia in diabetes patients

South Korea: The use of the diabetes drug pioglitazone may lower the risk of dementia in people with type 2 diabetes mellitus (T2DM), a recent study published in the journal Neurology has shown. The results were strongest among those with a stroke or ischemic heart disease history. 

The study does not prove that the drug reduces the risk of dementia for people with diabetes. It only shows an association.

“Since dementia develops for years before diagnosis, there may be an opportunity for intervening before it progresses,” said study author Eosu Kim, MD, PhD, of Yonsei University in Seoul, Republic of Korea. “These results may suggest that we could use a personalized approach to preventing dementia in people with diabetes if they have a history of ischemic heart disease or stroke.”

For the study, researchers looked at the national Korean health database for people newly diagnosed with type 2 diabetes who did not have dementia. They were followed for an average of 10 years. Of the 91,218 participants, 3,467 received the drug pioglitazone.

During the study, 8.3% of the people taking pioglitazone developed dementia, compared to 10.0% of those not taking the drug. After researchers accounted for other factors that could affect dementia risks, such as high blood pressure, smoking and physical activity, they found that people taking pioglitazone were 16% less likely to develop the disease than those who did not it. The benefit was stronger among people with a history of ischemic heart disease or stroke, with reduced risks of 54% and 43%.

The reduced risk also increased as people used the drug for longer periods. People who took the drug for four years were 37% less likely to develop dementia than those who did not, while those who took it for one to two years were 22% less likely.

During the study, people taking the drug were also less likely to have a stroke.

Kim noted that side effects of pioglitazone include swelling, weight gain, bone loss and congestive heart failure, and more research is needed on the drug's long-term safety and whether there is an optimal dose that could minimize side effects while maintaining the benefits.

“These results provide valuable information on who could benefit from pioglitazone use for the prevention of dementia,” Kim said. “In some previous studies of people with dementia or at risk of cognitive decline who did not have diabetes, pioglitazone did not show any protection against dementia, so it’s likely that a critical factor affecting the effectiveness is the presence of diabetes. More research is needed to confirm these findings.”

A limitation of the study was information on drugs was based on insurance claims, so it’s possible that some people did not take the drugs as prescribed.  

Reference:

Junghee Ha, Dong Woo Choi, Kim, Keun You Kim, Chung Mo Nam, Eosu Kim Neurology Feb 2023, DOI: 10.1212/WNL.0000000000207069