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Antidiabetic agents and dementia risk in type 2 diabetes: A systematic review and network meta-analysis
Kato S, Ozu N, Yamakage H, Kato H, Iuchi T, Suzuki R, Noto H, Tanaka M et al.. Diabetes, obesity & metabolism, 2025-10-22
Topic: Risk, prevention and care in population studies
Aims Certain antidiabetic agents may prevent dementia in patients with type 2 diabetes mellitus (T2DM). The purpose of this study is to elucidate the relative effect of antidiabetic agents on reducing dementia risk in patients with T2DM. Materials and methods PubMed, Cochrane Library and Igaku Chuo Zasshi-Web from inception to 31 December 2023 were searched. Trials reported in English or Japanese language that assessed the effects of glucose-lowering drugs on dementia were selected. Results Overall, 67 trials (4 088 683 individuals) assessing nine antidiabetic agent classes were included. Studies comprised monotherapies versus control (no use of antidiabetic agents or placebo) (three trials), monotherapies versus add-on therapies (one trial) and real-world database studies (63 trials). The analysis showed that the risk of dementia decreased with sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1-RA), thiazolidinediones (TZD) and dipeptidyl peptidase-4 inhibitors (DPP4i) compared with the reference (placebo, no use of antidiabetic agents or other antidiabetic agents). Conversely, insulin was associated with an increased risk of dementia, whereas no significant association was found with the use of metformin, sulfonylureas, glinides and α-glucosidase inhibitors. Analyses of treatment rankings further revealed the relative effect on reducing dementia risk in the following order: SGLT2i > GLP1-RA > TZD > DPP4i; insulin ranked the lowest. Conclusions The most effective antidiabetic agent in reducing dementia risk in T2DM is SGLT2i, followed by GLP1-RA, TZD and DPP4i, whereas insulin is associated with an elevated risk of dementia.
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APA 7th
Kato, S., Ozu, N., Yamakage, H., Kato, H., Iuchi, T., Suzuki, R., et al. (2026). Antidiabetic agents and dementia risk in type 2 diabetes: A systematic review and network meta-analysis. Diabetes, obesity & metabolism. https://doi.org/10.1111/dom.70182
Vancouver
Kato S, Ozu N, Yamakage H, Kato H, Iuchi T, Suzuki R, et al. Antidiabetic agents and dementia risk in type 2 diabetes: A systematic review and network meta-analysis. Diabetes, obesity & metabolism. 2026. doi:10.1111/dom.70182. PMID: 41126557.
BibTeX
@article{kato2026-41126557,
author = {Kato, S. and Ozu, N. and Yamakage, H. and Kato, H. and Iuchi, T. and Suzuki, R. and Noto, H. and Tanaka, M. and others},
title = {{Antidiabetic agents and dementia risk in type 2 diabetes: A systematic review and network meta-analysis}},
journal = {Diabetes, obesity \& metabolism},
year = {2026},
doi = {10.1111/dom.70182},
pmid = {41126557},
url = {https://doi.org/10.1111/dom.70182}
}
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Key findings
- Results Overall, 67 trials (4 088 683 individuals) assessing nine antidiabetic agent classes were included.
- Studies comprised monotherapies versus control (no use of antidiabetic agents or placebo) (three trials), monotherapies versus add-on therapies (one trial) and real-world database studies (63 trials).
- The analysis showed that the risk of dementia decreased with sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1-RA), thiazolidinediones (TZD) and dipeptidyl peptidase-4 inhibitors (DPP4i) compared with the reference (placebo, no use of antidiabetic agents or other antidiabetic agents).
- Conversely, insulin was associated with an increased risk of dementia, whereas no significant association was found with the use of metformin, sulfonylureas, glinides and α-glucosidase inhibitors.
- Analyses of treatment rankings further revealed the relative effect on reducing dementia risk in the following order: SGLT2i > GLP1-RA > TZD > DPP4i; insulin ranked the lowest.
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Study details
- Participants683
- Evidence strengthLow
How this study scored 72/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for effect reported because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 42 of the 58 points we could judge it on, which is 72 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Diabetes, obesity & metabolism) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 12 / 12 | A systematic review of all the studies on the question (from PubMed type “Systematic Review”) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 683 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | A review of other studies — randomization is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41126557) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 42 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 42 of the 58 points we could judge it on is 72 out of 100. |
| Total | 72 / 100 | — |
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