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Does Discontinuing Metformin Increase the Risk of Dementia?

Metformin and Dementia

Metformin and Dementia Risk: Does discontinuing metformin increase your risk of dementia? A study was performed to find a link between dementia in patients who discontinue metformin.

Key points of Discontinuing Metformin and Dementia Risk Study:

  1. This study looks into the relationship between dementia incidence in people without kidney disease and discontinuing metformin prescriptions.
  2. There is evidence that individuals who stop taking metformin are at an increased of developing dementia, which stresses the importance of compliance with metformin.
  3. Mediation analysis indicated that changes in HbA1c levels and insulin usage minimally contributed to the observed association between metformin discontinuation and dementia risk.

Most diabetics typically use Metformin as a means to manage blood glucose, however, the latest studies have revealed further benefits of this drug beyond glucose control.

A study from 2020 has concluded the association between metformin and weight loss.

They found out that weight reduction was evident in metformin users owing to metabolic changes. These changes included a reduction in hepatic gluconeogenesis and a drop in insulin production [Ref].

So, as a first-line treatment for diabetes, metformin has advantages beyond glycemic control.

In a study published this month, termination of metformin in individuals without kidney disease was associated with a high risk of dementia.

This association was 1.21 times higher in people who quit using metformin early in life [Ref].

Research has talked about this link before, as diabetics who were not on any anti-diabetes medication faced a severe chance of dementia in comparison to those who were using metformin. This risk was even lower in diabetics who were long-term metformin users [Ref].

So, the advantages of metformin are not limited to glucose management, and continuous research will help unfold mysteries about it.


Metformin and Dementia Risk: Study settings and analysis

metformin and dementia risk

Participants in the study were drawn from the Kaiser Permanente Northern California (KPNC) medical group.

Researchers compared people who quit using metformin with those who carried on. Their main goal was to determine whether metformin use and dementia are related.

Participants were followed from 1996 to 2020; researchers evaluated data and electronic health records.

The analysis of the association between dementia and metformin usage was done by taking into account variables like HbA1c levels and the status of insulin prescriptions.

Techniques like Cox proportional hazard models and causal mediation analysis were also performed.

In this study, 12,220 individuals who stopped using metformin early were included. Additionally, 29,126 participants continued with metformin throughout the study.

The study observed that discontinuing metformin without displaying abnormal kidney function markers was associated with a 1.21 times higher risk of dementia diagnosis compared to those who either continued metformin therapy or ceased it with abnormal kidney function markers.

This increase in dementia risk was only partially influenced by elevated HbA1c levels and not influenced by insulin use 1-5 years after discontinuing metformin.


What are other health benefits of metformin?

As mentioned above, this is a first-line treatment for diabetes, but its benefits do not stop at glucose management.

For decades, metformin’s positive effects on cardiovascular health have been studied [Ref].

A study from 2019 also concluded that it is capable of reducing CVD in pre-diabetic patients [Ref].

So, users can experience better cardiac health with metformin while maintaining their glucose levels [Ref].

There is an entire list of diseases that metformin protects its users from. In a study from 2022, cognitive dysfunction risk is greatly reduced by the use of metformin [Ref].

There is evidence that metformin can cross the blood-brain barrier, enhance cerebral energy metabolism [Ref], and protect the formation of amyloid plaque that causes memory impairment [Ref].

Furthermore, metformin is capable of extending an individual’s lifespan by reducing chances of all-cause mortality, cancer, stroke, and CVD [Ref].


How does diabetes link with dementia?

metformin and dementia risk in the elderly

Diabetes has been known to have hazardous impacts on patients. It can induce cognitive impairments in diabetics while also increasing the chances of dementia.

According to a study from 2016, type 2 diabetes and insulin resistance increase the risk of cognitive decline and dementia, suggesting a potential pathway for the development of both Alzheimer’s and vascular disease [Ref].

So, type 2 diabetes becomes a risk factor for dementia and Alzheimer’s disease. Also, diagnosis at an early age is linked to subsequent development of dementia later in life [Ref].

This association can be due to the effects of low sugar levels on memory. Hypoglycemia is capable of causing acute or chronic loss of memory in individuals [Ref], which continues to show how diabetics are at risk of dementia.

This link emphasizes the need to stay on metformin since research has proven its improving effects on cognition. However, diabetics find it hard to stick to metformin.


Why do patients stop using metformin?

Firstly, patients complain a lot about the size and texture of this pill, which makes them avoid adhering to this medication. This is a prominent reason why people stop using it, according to a study from 2019 [Ref].

Another reason reported by patients is the gastrointestinal side effects of this drug. Diarrhea and flatulence are two main reasons why these patients find it difficult to restart metformin [Ref].

Since metformin is the most widely used drug for diabetes, these issues should be solved immediately. A better formulation should be prescribed to maintain patient compliance with the medicine.

Considering the findings of this new study, patients must stick to metformin not for diabetes management but for several other health reasons.

There should be a thorough discussion between patients and physicians about the importance of compliance with metformin.


What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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