Association of sodium‐glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors with time to dementia: a population‐based cohort study
Notice bibliographique
Résumé
Abstract Background Preclinical evidence suggests that sodium‐glucose cotransporter‐2 (SGLT2) inhibitors may mitigate dementia pathology; however, current clinical evidence is limited. The primary aim is to compare dementia risk between SGLT2 inhibitors and dipeptidyl peptidase‐4 (DPP4) inhibitors, two common second‐line glucose‐lowering medications. Methods This population‐based retrospective cohort study utilized administrative databases housed at ICES (https://www.ices.on.ca/), and residents of Ontario, Canada with diabetes aged ≥66 years were included. Three different but overlapping new‐user cohorts were created. The primary comparison was SGLT2 inhibitors versus DPP4 inhibitors (entry period: January 1, 2016, to March 31, 2020). The secondary comparisons were SGLT2 inhibitors versus sulfonylureas (January 1, 2016, to March 31, 2020) and DPP4 inhibitors versus sulfonylureas (January 1, 2011, to March 31, 2020), because sulfonylureas are older second‐line therapies still used contemporaneously. Individuals were followed for maximum 4.5 years. The primary outcome was time to incident dementia. Exploratory outcomes were time to incident Parkinson’s disease diagnosis, stroke, and long‐term care admission, to examine outcomes related to both glucose‐lowering medications and dementia risk. Propensity‐score weighted Fine‐Gray subdistribution hazard models with all‐cause mortality as competing risk were used to obtain adjusted hazard ratios (aHR) and confidence intervals (CI). Results Among 119,432 individuals, SGLT2 inhibitors compared with DPP4 inhibitors were associated with lower risks of dementia (14.5/1000 person‐years, aHR [95% CI] = 0.59 [0.52‐0.67]), stroke (10.8/1000 person‐years, aHR [95% CI] = 0.87 [0.77‐0.99]), and long‐term care admission (8.6/1000 person‐years, aHR [95% CI] = 0.43 [0.36‐0.52]). SGLT2 inhibitors compared with sulfonylureas were associated with lower risks of dementia (11.0/1000 person‐years, aHR [95% CI] = 0.57 [0.51‐0.63]), Parkinson’s disease (1.7/1000 person‐years, aHR [95% CI] = 0.73 [0.56‐0.97]), stroke (9.8/1000 person‐years, aHR [95% CI] = 0.75 [0.63‐0.84]), and long‐term care admission (5.6/1000 person‐years, aHR [95% CI] = 0.51 [0.44‐0.59]) among 89,114 individuals. DPP4 inhibitors compared with sulfonylureas were associated with lower risks of dementia (16.5/1000 person‐years, aHR [95% CI] = 0.78 [0.74‐0.82]), stroke (10.4/1000 person‐years, aHR [95% CI] = 0.85 [0.79‐0.92]), and long‐term care admission (8.7/1000 person‐years, aHR [95% CI] = 0.82 [0.76‐0.89]) among 152,559 individuals. Conclusion SGLT2 inhibitor use was associated with lower dementia risk, and with preservation of functional independence, compared with DPP4 inhibitor or sulfonylurea use. Randomized controlled trials are needed to replicate the findings.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».