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Sunnybrook Research Institute

Walter Swardfager, PhD | Ontario, Canada

Sunnybrook Research Institute

Walter Swardfager, PhD | Ontario, Canada

Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists as Pharmacotherapies to Prevent Dementia

People with type 2 diabetes are more likely to develop dementia, but there are limited recommendations to slow or prevent this process. Because curative therapies for dementia remain lacking, it is essential to identify effective strategies, especially in the most vulnerable populations, to stop progression to dementia. Newer treatments for type 2 diabetes, the sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RAs), have been shown to protect the heart and blood vessels, but the effects on brain are not as clearly understood. Research with cells and animals shows that these drug classes may reduce dementia pathology such as amyloidosis, neuroinflammation, cerebrovascular damage, and oxidative stress. However, there is limited clinical evidence showing the effect of SGLT2 inhibitors or GLP1-RAs on dementia risk. Using real-world primary care data in the UK, this study aims to determine whether new users of SGLT2 inhibitors or new users of GLP1-RAs show slower progression to dementia, compared with new users of dipeptidyl peptidase-4 (DPP4) inhibitors. As GLP1-RAs, SGLT2 inhibitors, and DPP4 inhibitors are all second-line therapies for diabetes, the findings will suggest which drug class might be associated with the lowest dementia risk. Preplanned sensitivity analyses will determine if patient level factors such as sex and cardiovascular disease may influence these associations, as a possible step towards personalized medicine. The findings will support the opportunity to validate SGLT2 inhibitors and/or GLP1 receptor agonists as drugs to reduce dementia risk in clinical trials.