Researchers say that these results could help people at high risk of dementia choose the right medicines and that it might be worth putting these drugs at the top of the list for future research on repurposing.

A long-term study published in the open-access journal BMJ Open Diabetes Research & Care links the use of an older family of type 2 diabetes medicines called glitazones, often known as thiazolidinediones or TZDs, to a 22% lower risk of dementia.

Scientists suggest that these drugs may be able to prevent dementia in people who are at high risk and have mild or moderate type 2 diabetes. It may be worth giving them more attention in future clinical studies to see if they can be used for something else.

Due to the fact that type 2 diabetes and dementia have similar physiological processes, researchers have begun to investigate whether diabetes medications could possibly prevent or treat dementia. But the results haven’t been constant up to now.

To learn more about this, researchers compared the risk of dementia in older people with type 2 diabetes who were treated with a sulfonylurea or a thiazolidinedione (TZD) with the risk of dementia in those who were treated with metformin alone.

They used the electronic health records of 559,106 people with type 2 diabetes from the national Veteran Affairs (VA) Health System from January 2000 to December 2019.

Only older patients (at least 60 years old) who were prescribed metformin, a sulfonylurea (tolbutamide, glimepiride, glipizide, or glyburide), or a TZD (rosiglitazone or pioglitazone) for the first time between January 2001 and December 2017 (559,106) were part of the study. Their wellness was monitored on average for about 8 years.

When compared to metformin alone, use of a TZD alone was tied to a 22% lower risk of dementia from any cause after at least one year of pharmacological treatment.

Particularly, it was linked to a 57% lower risk of vascular dementia and an 11% lower risk of Alzheimer’s disease. Researchers believe that TZDs may help prevent dementia and Alzheimer’s disease in part due to their beneficial effects on the vascular system, given that vascular problems increase the risk of Alzheimer’s disease.

The risk of dementia from any cause was 11% lower when metformin and TZD were used together, but it was 12% higher when a sulfonylurea drug was used alone. This led the researchers to suggest that combining a sulfonylurea with metformin or a TZD may partially counteract these effects.

The researchers emphasize that more thorough study revealed that patients under 75 years old benefited more with a TZD than older patients, underscoring the need of early dementia prevention. And in patients who were overweight or obese, these medications also appeared to be more protective.

This is an observational study, therefore cause-and-effect conclusions aren’t possible. The researchers also admit that the study’s participants were primarily White men and that certain potentially significant information, such as renal function and genetic variables, was not available.

However, based on their findings, they advise that TZDs should be prioritized in future research for repurposing diabetes medicines for dementia prevention.

“These findings,” they write, “may help inform medication selection for [older] patients with [type 2 diabetes] at high risk of dementia.”

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