Study Finds No Significant Difference in Dementia Risk Between GLP-1 RAs and DPP4 Inhibitors in Older Adults with Type 2 Diabetes

Recent research published in the Annals of Internal Medicine indicates that for seniors with type 2 diabetes, the choice between glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 inhibitors (DPP4is) does not significantly influence the risk of developing dementia. The study analyzed data from Medicare beneficiaries aged 66 and older who were using metformin and initiating either GLP-1 RAs or DPP4is between January 2017 and December 2018.

A total of 2,418 patients starting on GLP-1 RAs were compared to 4,836 matched patients initiating DPP4is, with the average age around 71 years. Over a median follow-up period of nearly two years, 96 patients in the GLP-1 group and 217 in the DPP4i group developed dementia. The analysis showed that at 30 months, the risk difference was approximately -0.93%, and the risk ratio was around 0.83, suggesting no definitive benefit of one medication class over the other in reducing dementia risk.

Interestingly, when examining age subgroups, there was a hint that younger seniors (under 75) might experience a somewhat lower risk with GLP-1 RAs, with a risk ratio of 0.64. However, for those aged 75 and older, the risk appeared slightly higher, with a risk ratio of 1.22. Despite these observations, the overall evidence does not establish a causal relationship between the type of diabetes medication and dementia prevention.

This study provides valuable insights for clinicians managing older adults with diabetes, emphasizing that the selection of GLP-1 RAs or DPP4is should consider other factors beyond dementia risk. Further research is needed to clarify potential age-related effects and underlying mechanisms.

Source: https://medicalxpress.com/news/2025-07-dementia-differ-glp-ras-dpp4is.html