Findings: Over a mean follow-up of 3.04 years, SGLT2i use was associated with a significantly lower incidence of all-cause dementia (adjusted hazard ratio [aHR] 0.82, 95% CI 0.71–0.95) and unspecified dementia (aHR 0.75, 95% CI 0.62–0.90) compared with GLP-1 RA use. No statistically significant differences were observed for Alzheimer’s disease (aHR 0.96, 95% CI 0.73–1.26) or vascular dementia (aHR 0.77, 95% CI 0.53–1.12). Findings remained robust in competing risk analyses (aHR for all-cause dementia 0.84, 95% CI 0.73–0.98; unspecified dementia 0.77, 95% CI 0.64–0.93).
I’m pretty happy using both simultaneously for most individuals, unless there are contraindications. Also need to look at all cause mortality/morbidity and, if for example, a patient has a BMI of 35, I’d favor heavy on the GLP-1 as being the thing that will improve their outcomes the most, if their body weight is ideal, then the SGLT2-i would be favored.
I think the data looking at GLP-1’s and dementia vs. nothing looks good for benefit - it’s just the SGLT2-i has even more benefit.
Clearly there’s still a need for dedicated therapies and approaches for Alzheimer’s and vascular dementia. Taking care of CV health is likely helpful, but I keep thinking about Japan, where VD is at much higher comparative rate to AD as juxtaposed to the ratio in the West. And after all, Japan also has much lower rates of diabetes and CVD. Sure, these are epi statistics, but interesting nonetheless.
Just asking for advice as to wether to retry empagliflozin-have tried 2.5mg , 5mg //both just flattened me for 24hrs-no energy and peeing all the time. Is this something that goes away? I have never trued it for more than one day. I have 10mg tabs .
Your glucose levels are too low to keep up with your regular activity levels. That is something that your body could either get used to over a few months of using low dose empagliflozin or you need to deliberately eat more sugar.
Peeing all the time suggests to me that his glucose levels are quite high (thus lots of glucose being dumped and dragging water w/it into the urine). Someone with low glucose shouldn’t see much of an effect from an SGLT2I.
You need to get some bloodwork done before starting empagliflozin (or any drug). This is not a typical reaction. If a CGM works for you (tried repeatedly - it does not work for me) you might be interested to see how your blood glucose levels change with time of day/night, food intake, exercise - or use a glucose monitor (my current method). You need some baseline data before starting empagliflozin. Once you have that data you can monitor how empagliflozin impacts you and how it tracks with biomarkers.
So, I would start with getting baseline data: blood & urine tests, CGM (or glucose monitor) and only then start with a low dose empagliflozin 10mg/day and measure again.