Diabetes Drug and Dementia Risk

Recently, headlines appeared indicating a significant reduction in risk for dementia in type-2 diabetics who had been taking the drug pioglitazone, better known as Actos^®.

The news came following the publication of a Korean study that evaluated 91,000 newly-diagnosed diabetics with no history of dementia. In those using pioglitazone, the risk of developing dementia was 16% lower than in those not using the drug, and it appeared that the longer the drug was used (up to four years), the lower the dementia risk.

One of the authors of the study, Eosu Kim, MD, PhD commented in MEDPAGE TODAY, stating:

“Since dementia develops for years before diagnosis, there may be an opportunity for intervening before it progresses…These results provide valuable information on who could potentially benefit from pioglitazone use for prevention of dementia. “

This is intriguing information. But let’s dig a little deeper.

The results also indicated that in patients who had a history of a hemorrhagic stroke, (bleeding in the brain), risk of dementia in those taking pioglitazone was increased by more than 3-fold.

So, what are the important take-home messages?

First, the fact that the researchers found this relationship makes it clear that metabolic issues (which actually defines diabetes) may underlie cognitive decline. This is the reason we have been emphasizing dietary interventions for type-2 diabetes, and even in those with pre-diabetes. These interventions center on dramatically lowering the consumption of refined carbohydrates and welcoming healthful fat back to the table. In fact, this is the best approach to keeping people from becoming diabetic in the first place. And this is relevant to this commentary in that type-2 diabetes may increase dementia risk by as much as four-fold.

Second, diabetes medications are absolutely not without risk. As reported in MEDPAGE TODAY, related to pioglitazone:

In 2016, the FDA warned that the drug may be linked to an increased risk for bladder cancer based on findings from a 10-year epidemiologic study and added to the label that pioglitazone should not be used in patients with active bladder cancer. The label also has a boxed warning stating that pioglitazone may cause or worsen congestive heart failure for certain patient populations.

Here in America, there are close to 90 million individuals who are either diabetic or at least prediabetic. We need to be focusing our research and outreach on targeting why this is the case, and how we can prevent it in the first place. Blood sugar elevation threatens the entire body, including the heart, kidneys, and yes, the brain.

As such, let’s embrace what forward looking researchers are telling us about diet, the value of wearable devices like the continuous glucose monitor, the importance of keeping uric acid values in check, and the immeasurable benefit of regular exercise.