Metformin and risk of Alzheimer's disease among community-dwelling people with diabetes: a national case-control study
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Date
2020
Authors
Sluggett, J.K.
Koponen, M.
Bell, J.S.
Taipale, H.
Tanskanen, A.
Tiihonen, J.
Uusitupa, M.
Tolppanen, A.M.
Hartikainen, S.
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Journal of Clinical Endocrinology and Metabolism (JCEM), 2020; 105(4):e963-e972
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CONTEXT: Type 2 diabetes has been linked with an increased risk of Alzheimer's disease (AD). Studies on the association between metformin use and AD have reported conflicting results. OBJECTIVE: To investigate whether metformin use modifies the association between diabetes and incident, clinically verified AD. DESIGN: Nested case-control study. SETTING: All community-dwelling people in Finland. PARTICIPANTS: Cases were all community-dwelling Finns with AD diagnosed from 2005 to 2011 and with diabetes diagnosed ≥ 3 years before AD (n = 9862). Cases were matched with up to 2 control persons by age, sex, and diabetes duration (n = 19 550). MAIN OUTCOME MEASURE: Cumulative metformin exposure was determined from reimbursed dispensings over a 10- to 16-year period. Adjusted odds ratios (aORs) were calculated using conditional logistic regression to estimate associations, with adjustment for potential confounders.
RESULTS: A total of 7225 (73.3%) cases and 14528 (74.3%) controls received metformin at least once. Metformin use (ever use) was not associated with incident AD (aOR 0.99; 95% confidence interval [CI], 0.94-1.05). The adjusted odds of AD were lower among people dispensed metformin for ≥ 10 years (aOR 0.85; 95% CI, 0.76-0.95), those dispensed cumulative defined daily doses (DDDs) of < 1825-3650 (aOR 0.91; 95% CI, 0.84-0.98) and > 3650 DDDs (aOR 0.77; 95% CI, 0.67-0.88), and among persons dispensed an average of 2 g metformin daily (aOR 0.89; 95% CI, 0.82-0.96). CONCLUSION: In this large national sample we found no evidence that metformin use increases the risk of AD. Conversely, long-term and high-dose metformin use was associated with a lower risk of incident AD in older people with diabetes.
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Copyright 2019 Endocrine Society
Access Condition Notes: accepted manuscript available on open access