Alice Cheng, MD: Exploring the Link Between Diabetes and Dementia

In this expert interview at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Alice Cheng, MD, an endocrinologist at the University of Toronto, discussed the connection between diabetes and dementia, highlighting the complex mechanisms, including inflammation, brain insulin resistance, and metabolic disturbances.

Although glycemic control has not been shown to reduce dementia risk, observational data suggest that certain diabetes drugs, like metformin, pioglitazone, GLP-1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter 2 (SGLT2) inhibitors, may offer protective benefits for cognitive function, with some exploratory studies, such as the REWIND study with dulaglutide, showing the potential improvements in cognition in some patients.

Cheng emphasized the need for larger, randomized controlled trials to better understand the impact of these drugs on dementia, with promising studies underway, including Phase 3 investigations into oral semaglutide’s effect on Alzheimer’s disease, as well as oral semaglutide plus intranasal insulin. She also noted that while lifestyle factors like healthy eating, physical activity, and weight management remain critical for brain health, glycemic control should still be prioritized for overall health. Finally, Cheng recommended routine cognitive assessments in clinical practice, particularly in patients on insulin, to detect dementia early and ensure safe medication management.

Reflecting on the past year, Cheng highlighted the increasing role of GLP-1 RAs, particularly in managing conditions like chronic kidney disease (CKD) and heart failure with preserved ejection fraction (HFpEF), with studies like FLOW and drugs like tirzepatide offering exciting new insights into these medications' broader potential.

Relevant disclosures for Cheng include AstraZeneca, Bayer, Eli Lilly, Novo Nordisk, Sanofi, and others.

Reference

Cheng A. Diabetes, Drugs, and Dementia Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.