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Background Type 2 diabetes mellitus (T2DM) and dementia cause heavy health burden in mainland China, where few studies have investigated the association between glucose‐lowering agents and dementia risk. We aimed to assess the association between use of thiazolidinediones (TZDs) and dementia incidence in a mainland Chinese population with T2DM. Methods A retrospective cohort of T2DM patients who were new users of TZDs or alpha glucosidase inhibitors (AGIs) was assembled using the Yinzhou Regional Health Care Database. A Cox model with inverse probability of treatment weighting (IPTW) for controlling potential founding was applied to estimate the hazard ratio (HR) of the association between use of TZDs and dementia risk. Results A total of 49 823 new users of AGIs and 12 752 new users of TZDs were included in the final cohort. In the primary analysis, the incidence of dementia was 195.7 and 78.2 per 100 000 person‐years in users of AGIs and TZDs respectively. TZD use was associated with a reduced risk of incident dementia after adjusting for potential confounding using IPTW, with a HR of 0.51 (95% CI, 0.38–0.67). The results in various subgroup analyses and sensitivity analyses were consistent with the findings of the primary analysis. Conclusions Use of TZDs is associated with a decreased risk of dementia incidence in a mainland Chinese population with T2DM. 摘要 背景:2型糖尿病(T2DM)和痴呆给患者带来严重的健康负担，但目前很少有研究探讨降糖药物与痴呆风险之间的关系。我们旨在评估T2DM人群中噻唑烷二酮类药物的使用与痴呆发病率之间的关系。 研究设计和方法:利用鄞州地区卫生保健数据库，对新使用噻唑烷二酮(TZDs)或α‐糖苷酶抑制剂(AGIs)的2型糖尿病患者进行回顾性队列研究。采用治疗加权逆概率(IPTW)控制潜在发病的Cox模型来估计TZD使用与痴呆风险之间的关联的风险比(HR)。 结果:最终队列共纳入49823名AGIs新用户和12752名TZDs新用户。在初步分析中，AGIs和TZDs使用者的痴呆发病率分别为每10万人195.7/年和78.2/年。在使用IPTW进行潜在混杂调整后，TZDs的使用与痴呆事件风险降低相关，HR为0.51(95%CI,0.38‐0.67)。不同亚组分析和敏感性分析的结果与初步分析的结果一致。 结论:在2型糖尿病人群中，使用TZDs与痴呆发病率降低相关。 Highlights Type 2 diabetes mellitus (T2DM) and dementia cause heavy health burden in China. This was the first cohort study investigating the association between TZD use and dementia incidence in a mainland Chinese population. We found that TZD use was associated with a 49% reduction in incidence of dementia. Our results could provide some insights into developing effective prevention and control measures to reduce the future disease burden of dementia.

摘要 背景:2型糖尿病(T2DM)和痴呆给患者带来严重的健康负担，但目前很少有研究探讨降糖药物与痴呆风险之间的关系。我们旨在评估T2DM人群中噻唑烷二酮类药物的使用与痴呆发病率之间的关系。 研究设计和方法:利用鄞州地区卫生保健数据库，对新使用噻唑烷二酮(TZDs)或α‐糖苷酶抑制剂(AGIs)的2型糖尿病患者进行回顾性队列研究。采用治疗加权逆概率(IPTW)控制潜在发病的Cox模型来估计TZD使用与痴呆风险之间的关联的风险比(HR)。 结果:最终队列共纳入49823名AGIs新用户和12752名TZDs新用户。在初步分析中，AGIs和TZDs使用者的痴呆发病率分别为每10万人195.7/年和78.2/年。在使用IPTW进行潜在混杂调整后，TZDs的使用与痴呆事件风险降低相关，HR为0.51(95%CI,0.38‐0.67)。不同亚组分析和敏感性分析的结果与初步分析的结果一致。 结论:在2型糖尿病人群中，使用TZDs与痴呆发病率降低相关。