GLP-1 RAs Beat Metformin for Dementia Prevention in T2D: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 24, 2025, we reported on a study published in BMJ Open Diabetes Research & Care that was designed to compare the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and metformin in reducing the risk of dementia.

The study

Investigators conducted a retrospective cohort study using data from a global health research network between 2004 and 2024. Eligible individuals were adults with type 2 diabetes (T2D) without prior dementia who initiated either a GLP-1 RA or metformin as first-line treatment and had no history of insulin or other glucose-lowering drug use. Propensity score matching was applied to balance demographic and clinical variables between the treatment groups.

The findings

Among 87 229 matched patients per cohort, GLP- 1 RA use was associated with a significantly lower risk of overall dementia (adjusted HR (AHR) 0.90, 95% CI 0.85-0.95), Alzheimer disease (AD) (AHR 0.88, 95% CI 0.83-0.94), and nonvascular dementias (AHR 0.75, 95% CI 0.70-0.81) compared with metformin. No significant difference was observed for vascular dementias, according to the results.

Authors' comments

"These findings support the early use of GLP- 1 RAs in patients with T2DM at risk for cognitive decline and may influence future diabetes treatment guidelines to prioritize therapies with dual glycemic and neuroprotective benefits."

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