Association of sulfonylureas with the risk of dementia: A population‐based cohort study.
Background: Sulfonylureas are oral glucose‐lowering medications positioned as a second‐line therapy for type 2 diabetes. Evidence relating them to cognitive decline has been mixed. The objective was to determine whether sulfonylurea use was associated with a differential risk of dementia compared wi...
| Publicado en: | Journal of the American Geriatrics Society Vol. 71; no. 10; pp. 3059 - 3071 |
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| Autores principales: | , , , , , , , , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Wiley-Blackwell
Oct2023
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=172913261&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 172913261 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Oct2023 vid: 71 iid: 10 pid: 480 pub: Wiley-Blackwell artinfo: ui: 172913261 10.1111/jgs.18397 ppf: 3059 ppct: 12 formats: tig: atl: Association of sulfonylureas with the risk of dementia: A population‐based cohort study. aug: au: Wu, Che‐Yuan Iskander, Carina Wang, Christa Xiong, Lisa Y. Shah, Baiju R. Edwards, Jodi D. Kapral, Moira K. Herrmann, Nathan Lanctôt, Krista L. Masellis, Mario Swartz, Richard H. Cogo‐Moreira, Hugo MacIntosh, Bradley J. Rabin, Jennifer S. Black, Sandra E. Saskin, Refik Swardfager, Walter affil: Department of Pharmacology and Toxicology, University of Toronto, Toronto Ontario,, Canada Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto Ontario,, Canada ICES, Toronto Ontario,, Canada Divisions of Endocrinology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto Ontario,, Canada University of Ottawa Heart Institute, University of Ottawa, Ottawa Ontario,, Canada School of Epidemiology and Public Health, University of Ottawa, Ottawa Ontario,, Canada ICES, Ottawa Ontario,, Canada Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto Ontario,, Canada Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto Ontario,, Canada Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto Ontario,, Canada Department of Psychiatry, University of Toronto, Toronto Ontario,, Canada KITE University Health Network Toronto Rehabilitation Institute, Toronto Ontario,, Canada Toronto Dementia Research Alliance, Toronto Ontario,, Canada Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto Ontario,, Canada Faculty of Education, ICT, and Learning, Østfold University College, Halden, Norway Department of Medical Biophysics, University of Toronto, Toronto Ontario,, Canada Computational Radiology & Artificial Intelligence (CRAI), Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto Ontario,, Canada Rehabilitation Sciences Institute, University of Toronto, Toronto Ontario,, Canada su: Public health surveillance Retrospective studies Dementia risk factors Alzheimer's disease Confidence intervals Insulin secretagogues Hypoglycemic agents Risk assessment Type 2 diabetes Comparative studies Descriptive statistics Research funding Odds ratio Longitudinal method Enzyme inhibitors Algorithms Proportional hazards models Disease complications sug: subj: Public health surveillance Retrospective studies Dementia risk factors Alzheimer's disease Confidence intervals Insulin secretagogues Hypoglycemic agents Risk assessment Type 2 diabetes Comparative studies Descriptive statistics Research funding Odds ratio Longitudinal method Enzyme inhibitors Algorithms Proportional hazards models Disease complications keyword: dementia diabetes dipeptidyl peptidase‐4 (DPP4) inhibitors sulfonylureas dementia diabetes dipeptidyl peptidase‐4 (DPP4) inhibitors sulfonylureas ab: Background: Sulfonylureas are oral glucose‐lowering medications positioned as a second‐line therapy for type 2 diabetes. Evidence relating them to cognitive decline has been mixed. The objective was to determine whether sulfonylurea use was associated with a differential risk of dementia compared with dipeptidyl peptidase‐4 (DPP4) inhibitor use. Methods: Using administrative data from residents in Ontario, Canada, adults aged ≥66 years who were new users of a sulfonylurea or a DPP4 inhibitor from June 14, 2011, to March 31, 2021 entered this population‐based retrospective cohort study. Dementia was ascertained 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 confidence intervals (CI) for time to incident dementia. The observation window started at 1 year after cohort entry to mitigate protopathic bias due to delayed diagnosis. The primary analysis used an intention‐to‐treat exposure definition. A separate propensity‐score weighted analysis was conducted to explore within‐class differences in dementia risk among sulfonylurea new users selected from the primary cohort. Results: Among 107,806 DPP4 inhibitor new users and 37,030 sulfonylurea new users, sulfonylureas compared with DPP4 inhibitors were associated with a higher risk of dementia (18.4/1000 person‐years; aHR [95% CI] = 1.09 [1.04–1.15]) over a mean follow‐up of 4.82 years from cohort entry. Glyburide compared to gliclazide exhibited a higher dementia risk (aHR [95% CI] = 1.17 [1.03–1.32]). Conclusion: New use of a sulfonylurea especially glyburide was associated with a higher dementia risk compared with new use of a DPP4 inhibitor in older adults with diabetes. See related Editorial by Lee et al. in this issue. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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