Metformin may be a viable preventive measure against delirium in older adults with type 2 diabetes, according to a study recently published in Diabetes Care.

Delirium is not only a precursor but also a risk factor for dementia, making its prevention critical for long-term cognitive health, according to the study.

“Diabetes-related delirium is a significant concern in the management of type 2 diabetes (T2D) in older adults because of its impact on cognitive health and its role as a precursor to dementia,” Mingyang Sun, MD, from the department of anesthesiology and perioperative medicine at the People’s Hospital of Zhengzhou University and Henan Provincial People’s Hospital, China, and colleagues and colleagues wrote. “Given that delirium serves as both a precursor and a risk factor for dementia, particularly Alzheimer disease and vascular dementia, there is an urgent need for effective prevention and management strategies in adults with T2D.”

To evaluate the protective effects of metformin against delirium in patients aged 65 years and older with T2D, the researchers conducted a competing risk analysis to evaluate metformin’s impact on delirium, accounting for death as a competing factor.

The study included a cohort of 66,568 metformin users matched by propensity score to an equal number of nonusers. Risk assessment for delirium and mortality utilized multivariable Cox regression and the Fine and Gray method.

According to the researchers, metformin use was linked to a significantly lower risk of delirium, with adjusted hazard ratios between 0.77 and 0.81. A dose-response relationship was noted, suggesting that higher cumulative and daily doses of metformin provided even greater protection.

Although metformin reduced risk of delirium, with higher doses, the researchers suggest that the findings should be interpreted with caution and further researcher is warranted before considering changes to practice or guidelines.

“In conclusion, our study demonstrates that metformin use is associated with a significantly reduced risk of delirium in older adults with T2D, particularly with higher cumulative and daily doses,” Mingyang and colleagues wrote. “These findings indicate a potential benefit of metformin in reducing the incidence of delirium, which may contribute to better cognitive health outcomes in this vulnerable population.”

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Disclosures: No authors declared financial ties to drugmakers.

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