Older Class of Type 2 Diabetes Drugs Linked to 22% Reduced Dementia Risk

 For discussion with your doctor.

Your risk of dementia, has your doctor told you of this?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

What is your doctor's EXACT PROTOCOL TO PREVENT DEMENTIA?

Older Class of Type 2 Diabetes Drugs Linked to 22% Reduced Dementia Risk

Among patients with type 2 diabetes, use of thiazolidinediones (TZDs) was linked to a 22% reduced risk of dementia, according to a study published in BMJ Open Diabetes Research & Care.

These drugs may effectively prevent dementia in patients at high risk with mild or moderate type 2 diabetes, and may now be worth prioritising in future clinical studies to see if they can be repurposed, according to Jin J. Zhou, University of California Los Angeles, Los Angeles, California, and colleagues. 

For the current study, the researchers drew on the electronic health records of 559,106 people diagnosed with type 2 diabetes from the national Veteran Affairs (VA) Health System. All patients were aged at least 60 years and were given a first prescription of metformin, or a sulfonylurea (tolbutamide, glimepiride, glipizide, or glyburide), or a TZD (rosiglitazone or pioglitazone) between January 2001 and December 2017. Their health was tracked for an average of nearly 8 years.

After at least 1 year of drug treatment, use of a TZD alone was associated with a 22% lower risk of dementia from any cause, compared with the use of metformin alone. Specifically, it was associated with an 11% lower risk of Alzheimer’s disease and a 57% lower risk of vascular dementia.

Given that vascular diseases increase the risk of Alzheimer’s disease, TZDs may also help to reduce dementia and Alzheimer’s disease in part through their favourable effects on the vascular system, the authors said. 

While the risk of dementia from any cause was 11% lower for the use of metformin and TZD combined, it was 12% higher for the use of a sulfonylurea drug alone, prompting the researchers to suggest that supplementing a sulfonylurea with either metformin or a TZD may partially offset these effects. 

Further in-depth analysis indicated that those aged younger than 75 years benefited more from a TZD than older patients, highlighting the importance of early prevention for dementia.

The authors noted that the study was observational, so definitive conclusions can’t be drawn about cause and effect. They also acknowledged that certain potentially influential information wasn’t available, including kidney function and genetic factors, and that study participants were predominantly male and White. They suggest that future studies for repurposing diabetes drugs for dementia prevention might want to consider prioritising TZDs, based on their findings.

Reference: https://drc.bmj.com/content/10/5/e002894 

SOURCE: BMJ

Diabetes Medications May Reduce Alzheimer’s Disease Severity

Ask your doctor and not politely; would this help in preventing Alzheimers? Your doctor and stroke hospital should be excited about this and raring to go to get research done on this preventing Alzheimers. At least they should be if they were competent at all. 

Diabetes Medications May Reduce Alzheimer’s Disease Severity

People with Alzheimer’s disease who were treated with diabetes drugs showed considerably fewer markers of the disease, including abnormal microvasculature and dysregulated gene expressions in their brains compared with patients with Alzheimer’s disease who did not receive treatment for diabetes, according to a study published in PLOS One.
The study is the first to examine what happens in the pathways of both brain tissue and endothelial cells in the brains of patients with Alzheimer’s disease treated with diabetes medication.
Two previous studies on brain tissue found that the brains of people with both Alzheimer’s disease and diabetes had fewer Alzheimer’s lesions than the brains from people with Alzheimer’s disease without diabetes.
To determine what happens at the molecular level, researchers from Mount Sinai, New York, New York, developed a method to separate brain capillaries from the brain tissue of 34 people with Alzheimer’s and type 2 diabetes who had been treated with anti-diabetes drugs and compare them with tissue from 30 brains of people with Alzheimer’s without diabetes and 19 brains of people without Alzheimer’s or diabetes. They then examined the vessels and brain tissue separately to measure Alzheimer’s disease associated changes in molecular RNA markers for brain capillary cells and insulin signalling.
The levels of about half of these markers were reduced in the vessels and brain tissue in the group with Alzheimer’s and diabetes. The great majority of the RNA changes seen in Alzheimer’s disease were absent in those Alzheimer’s patients who had been treated with anti-diabetes drugs.
“The results of this study are important because they give us new insights for the treatment of Alzheimer’s disease,” said senior author Vahram Haroutunian, PhD, Icahn School of Medicine at Mount Sinai. “Most modern Alzheimer’s treatments target amyloid plaques and haven’t succeeded in effectively treating the disease. Insulin and diabetes medications such as metformin are FDA approved and safely administered to millions of people and appear to have a beneficial effect on people with Alzheimer’s disease.”
“This opens opportunities to conduct research trials on people using similar drugs or on drugs that have similar effects on the brains’ biological pathways and cell types identified in this study,” he said.
Reference: https://doi.org/10.1371/journal.pone.0206547
SOURCE: Mount Sinai Health System

Why a drug for aging would challenge Washington

This is only posted so I can refer once again to the suggested drug as quite possibly being useful for a hyperacute stroke intervention. But I have no one to go to to get this into a stroke strategy or protocol. Stroke survivors will forever be screwed until we get some leadership.  I'm going to ask for this drug after my next stroke.  My doctor is not going to know what hit her when I tell her how she is going to treat me.
Why a drug for aging would challenge Washington 

You'll have to read the story at the link, but they refer to an old diabetes drug - metformin.

My earlier posts here:

Why a Diabetes Drug Could Help in Parkinson’s Disease August 2017

 

Early glycemic control with metformin cuts CVD events for diabetes patients 

April 2017

You could stay forever young (or young for a long time) with this diabetes drug 

Dec. 2015

In this one is this line:The drug, which is cheaply available for just $0.16 a day, works by boosting the number of oxygen molecules released into a cell, which in turn seems to benefit the robustness and longevity of the body’s basic building blocks. (This would seem to be much easier and faster than HBOT)

 

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack

Follow-up needed which will never occur.
Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack

• 
  

  1. Xuanwu Hospital, Capital Medical University, Department of Neurology, Beijing, China

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• 
  

  Corresponding author
  

  1. Chinese PLA General Hospital, Department of Geriatric Neurology, Beijing, China

  • Lu-Ning Wang, Department of Geriatric Neurology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China. ln_wang301@sohu.com.

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• First published: 2 December 2017
• Editorial Group: Cochrane Stroke Group
• DOI: 10.1002/14651858.CD010693.pub4  View/save citation
• Cited by (CrossRef): 0 articles Check for updates

Abstract

Background

Peroxisome proliferator-activated receptor gamma (PPAR-γ) agonists are insulin-sensitising drugs used for the treatment of insulin resistance. In addition to lowering glucose in diabetes, these drugs may also protect against hyperlipidaemia and arteriosclerosis, which are risk factors for stroke. This is an update of a review first published in January 2014 and subsequently updated in October 2015.

Objectives

To assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular events for people with stroke or transient ischaemic attack (TIA).

Search methods

We searched the Cochrane Stroke Group Trials Register (16 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 5), MEDLINE (1949 to 16 May 2017), Embase (1980 to 16 May 2017), CINAHL (1982 to 16 May 2017), AMED (1985 to 16 May 2017), and 11 Chinese databases (16 May 2017). In an effort to identify further published, unpublished, and ongoing trials, we searched ongoing trials registers, reference lists, and relevant conference proceedings, and contacted authors and pharmaceutical companies. We did not impose any language restrictions.

Selection criteria

We included randomised controlled trials (RCTs) evaluating PPAR-γ agonists versus placebo for the secondary prevention of stroke and related vascular events in people with stroke or TIA, with the outcomes of recurrent stroke, vascular events, and adverse events.

Data collection and analysis

Two review authors independently screened the titles and abstracts of identified records, selected studies for inclusion, extracted eligible data, cross-checked the data for accuracy, and assessed methodological quality and risk of bias. We evaluated the quality of evidence for each outcome using the GRADE approach.

Main results

We identified five RCTs with 5039 participants; two studies had a low risk of bias for all domains. Four studies evaluated the drug pioglitazone, and one study evaluated rosiglitazone. The participants in different studies were heterogeneous.

Recurrent stroke

Three studies evaluated the number of participants with recurrent stroke (4979 participants, a single study contributing 3876 of these). Peroxisome proliferator-activated receptor gamma agonists probably reduce the recurrence of stroke compared with placebo (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.44 to 0.99; moderate-quality evidence).

Adverse events

Evidence that adverse events occurred more frequently in participants treated with PPAR-γ agonists when compared with placebo was uncertain due to wide confidence interval and high levels of statistical heterogeneity: risk difference 10%, 95% CI -8% to 28%; low-quality evidence).

Data were available on additional composite outcomes reflecting serious vascular events (all-cause death and other major vascular events; all-cause mortality, non-fatal myocardial infarction or non-fatal stroke) from one study in 984 people. This study provided low-quality evidence that PPAR-γ agonists led to fewer events (data not meta-analysed).

Vascular events

Peroxisome proliferator-activated receptor gamma agonists given over a mean duration of 34.5 months in a single trial of 984 participants may reduce serious vascular events expressed as a composite outcome of total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke (RR 0.73, 95% CI 0.54 to 0.99; low-quality evidence).

Other outcomes

One study in 20 people measured insulin sensitivity, and one study in 40 people measured the ubiquitin-proteasome activity in carotid plaques. Our confidence in the improvements observed with PPAR-γ agonists were limited by small sample sizes and risk of bias. None of the studies reported the number of participants with disability due to vascular events or improvement in quality of life.

Authors' conclusions

Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular events in people with stroke or TIA.

Plain language summary

Diabetes drugs for preventing stroke and other blood vessel disease in people who have had a previous stroke or transient ischaemic attack

Question

We wanted to evaluate the effectiveness and safety of new diabetes drugs (peroxisome proliferator-activated receptor gamma (PPAR-γ) agonists) in the prevention of stroke and related blood vessel disease in people who have already had a stroke or transient ischaemic attack.

Background

Peroxisome proliferator-activated receptor gamma agonists are drugs that improve the way insulin works in the human body. They are widely used in the treatment of adult type diabetes (type 2 diabetes). Moreover, they may also protect against the presence of excess fats in the blood and disease of the artery walls, which are both risk factors for stroke.

Study characteristics

We identified five studies to 16 May 2017 including a total of 5039 participants. Four studies evaluated the drug pioglitazone, and one study evaluated rosiglitazone. Four studies included participants who had no history of diabetes, and one study included only participants with diabetes.

Key results

Compared with placebo tablets, PPAR-γ agonists reduced recurrent strokes and other blood vessel disease, improved the body's response to insulin, and stabilised fatty deposits in artery walls. The drugs also appeared to be well tolerated, but the evidence for this was inconclusive.

Quality of the evidence

Our conclusions should be interpreted with caution considering the small number of included studies and the limited quality of some of the studies. Further well-designed randomised controlled trials with large sample sizes are required.

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