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. 2019 Jul;17(4):352-362.
doi: 10.1370/afm.2415.

Association Between Metformin Initiation and Incident Dementia Among African American and White Veterans Health Administration Patients

Jeffrey F Scherrer  1   2 , John E Morley  3 , Joanne Salas  4   2 , James S Floyd  5   6   7 , Susan A Farr  3   8 , Sascha Dublin  5   9
Affiliations

Association Between Metformin Initiation and Incident Dementia Among African American and White Veterans Health Administration Patients

Jeffrey F Scherrer et al. Ann Fam Med. 2019 Jul.

Abstract

Purpose: African American patients are more likely to experience cognitive decline after type 2 diabetes mellitus onset than white patients. Metformin use has been associated with a lower risk of dementia compared with sulfonylureas. Evidence for whether this association differs by race is sparse.

Methods: Veterans Health Administration (VHA) medical record data were obtained for 73,761 African American and white patients aged ≥50 years who used the VHA from fiscal years 2000 to 2015. Patients were free of dementia and diabetes medications during fiscal years 2000 and 2001 and subsequently initiated metformin or sulfonylurea monotherapy. For race and age subgroups, Cox proportional hazards models using propensity scores and inverse probability of treatment weighting to control for confounding were computed to measure the association between metformin vs sulfonylurea initiation and incident dementia.

Results: After controlling for confounding, among patients aged ≥50 years, metformin vs sulfonylurea use was associated with a significantly lower risk of dementia in African American patients (hazard ratio [HR] = 0.73; 95% CI, 0.6-0.89) but not white patients (HR = 0.96; 95% CI, 0.9-1.03). The strongest magnitude of association between metformin and dementia was observed among African American patients aged 50 to 64 years (HR = 0.6; 95% CI, 0.45-0.81). Among those aged 65 to 74 years, metformin was significantly associated with lower risk of dementia in both races. Metformin was not associated with dementia in patients aged ≥75 years.

Conclusions: Metformin vs sulfonylurea initiation was associated with a substantially lower risk of dementia among younger African American patients. These results may point to a novel approach for reducing the risk of dementia in African Americans with type 2 diabetes mellitus.

Keywords: dementia; diabetes; epidemiology; medical records; metformin.

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Figures

Figure 1
Figure 1
Veterans Health Administration eligibility criteria. FY = fiscal year; HbA1c = hemoglobin A1c; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; MET = metformin; nSES = neighborhood socioeconomic status; SU = sulfonylurea.
Figure 2a
Figure 2a
Covariate standardized mean difference (SMD), metformin vs sulfonylurea, white race. HbA1c = hemoglobin A1c; NSAIDs = nonsteroidal anti-inflammatory drugs; nSES = neighborhood socioeconomic status; PTSD = posttraumatic stress disorder; VHA = Veterans Health Administration.
Figure 2b
Figure 2b
Covariate standardized mean difference (SMD), metformin vs sulfonylurea, African American race. HbA1c = hemoglobin A1c; NSAIDs = nonsteroidal anti-inflammatory drugs; nSES = neighborhood socioeconomic status; PTSD = posttraumatic stress disorder; VHA = Veterans Health Administration
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