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Cosmos Study

GLP-1 Medications Associated with Reduced Likelihood of Dementia Compared to Other Diabetic Meds

December 5, 2024
Dual-Team Study
Team A:Kersten Bartelt, RNGregory Edwards, PhD
Team B:Christopher Alban, MDEric Barkley

Key Findings

  • Patients with diabetes who are prescribed semaglutide, exenatide, liraglutide, or dulaglutide experience a 23–44% reduced likelihood of dementia compared to those prescribed other diabetes management medications. 

There have been reports on the relationship between GLP-1 medications and dementia, with some finding a reduced risk of dementia following a GLP-1 medication prescription1 and others indicating variability depending on how these medications cross the blood-brain barrier.2 

To further understand this relationship, we studied 549,822 patients with diabetes aged 60 or older. These patients were prescribed either a GLP-1 medication or another type of diabetes management medication and were observed for a dementia diagnosis within five years of starting the medication. We adjusted for patient age, sex, race, ethnicity, Social Vulnerability Index quintile, starting BMI, weight change after treatment, history of insulin usage, and starting HbA1c. For this study, dementia was defined to include Alzheimer’s disease as well as vascular and non-vascular dementias. 

We found that patients prescribed semaglutide had a 44% reduced likelihood of a dementia diagnosis compared to those prescribed a non-GLP-1 diabetes management medication, as seen in Figure 1. Similarly, patients prescribed exenatide experienced a 32% reduced likelihood, those prescribed liraglutide had a 27% reduced likelihood, and those prescribed dulaglutide had a 23% reduced likelihood.  

Figure 1
Five-Year Likelihood of Dementia Diagnosis by Diabetes Medication
Five-Year Likelihood of Dementia Diagnosis by Diabetes Medication
Figure 1. The likelihood of a diabetic patient being diagnosed with dementia within five years by medication.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 277 million patient records from 1,500 hospitals and more than 36,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

References

  1. Tang B, Sjölander A, Wastesson JW, et al. Comparative effectiveness of glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, and sulfonylureas on the risk of dementia in older individuals with type 2 diabetes in Sweden: an emulated trial study. EClinicalMedicine. 2024;73(102689):102689. doi:10.1016/j.eclinm.2024.102689 
  2. Fessel J. All GLP-1 agonists should, theoretically, cure Alzheimer’s dementia but dulaglutide might be more effective than the others. J Clin Med. 2024;13(13):3729. doi:10.3390/jcm13133729