The link between diabetes drugs and multiple sclerosis
Abstract: People over the age of 45 who use antihyperglycemic drugs to control type 2 diabetes have an increased risk of developing multiple sclerosis. However, those who are younger than 45 and taking antihyperglycemic drugs have a lower risk of MS.
Source: University of Arizona
A new study from the University of Arizona Health Sciences found that people older than 45 whose type 2 diabetes was treated with antihyperglycemic drugs had an increased risk of multiple sclerosis, especially among women, while exposure to antihyperglycemic drugs in people younger than 45 reduced that risk.
“Our findings reinforce the need for a precision medicine approach to MS prevention in these vulnerable populations,” said study leader Dr. Kathleen Rodgers, associate director of translational neuroscience at the Center for Brain Science Innovation.
Multiple sclerosis (MS) is an unpredictable autoimmune neurological disorder that affects the central nervous system and leads to severe physical and cognitive disability. It is estimated that nearly 1 million adults in the US and more than 2.8 million worldwide are living with MS.
For people with type 2 diabetes, there is increasing evidence linking metabolic disorders and MS through a common driver of increased autoimmunity. This calls into question the impact of antihyperglycemic therapeutics used to treat type 2 diabetes, including insulin, on the incidence of MS.
“Previous research has shown a neuroprotective effect of antihyperglycemic drugs in Alzheimer’s disease and other related dementias,” said Dr. Rodgers. “For MS, we wanted to further examine age and gender differences, particularly among men and women younger than 45 with type 2 diabetes.”
They found that men older than 45 years had a slightly significant increase in the risk of MS, and women older than 45 years showed a significant increase in the incidence of MS after antihyperglycemic exposure. In addition to age differences, analysis of risk by drug group showed that exposure to insulin in patients older than 45 years was associated with a greater increased risk compared with other therapies.
In patients younger than 45 years, antihyperglycemic exposure was protective against the development of MS.
The study used a US-based insurance claims database of 151 million participants to identify more than 5 million patients diagnosed with type 2 diabetes and either early-onset or late-onset MS. The researchers segmented the data by age – patients diagnosed with type 2 diabetes before or after age 45 – and gender to decode the factors that lead to MS risk in both populations, particularly in women over 45.
The paper “Age and Gender Differences in Antihyperglycemic Drug Exposure and Risk of Newly Diagnosed Multiple Sclerosis in Propensity Score-matched Type 2 Diabetics” was recently published in the journal Rogue.
Co-authors from the Center for Innovation at Brian Science include Dr. Roberta Diaz Brinton, director and Regents Professor; Ph.D. Francesca Vitali, research assistant in neurology; Georgina Torrandell-Haro, PhD student and research assistant; and Gregory Branigan, PhD, a third-year medical student at the University of Arizona Medical School – Tucson’s MD-PhD program.
Financing: This research was supported in part by the National Institute on Aging (P01AG026572, T32AG061897, R37AG053589) and the National Institute of Neurological Disorders and Stroke (R25NS107185), both divisions of the National Institutes of Health.
About this news about multiple sclerosis and diabetes research
Original research: Open access.
“Age and gender differences in antihyperglycemic drug exposure and risk of newly diagnosed multiple sclerosis in propensity score-matched type 2 diabetics” Kathleen Rodgers et al. Rogue
Age and gender differences in antihyperglycemic drug exposure and risk of newly diagnosed multiple sclerosis in propensity score-matched type 2 diabetics
The association between exposure to antihyperglycemic drugs (A-HgM) for the treatment of type 2 diabetes mellitus (T2D) and multiple sclerosis (MS) in patients with T2D is unclear.
The Mariner database was used in this retrospective cohort analysis. Patient data were examined for MS diagnosis beginning 12 months after T2D diagnosis. Patients had to be actively enrolled in the Mariner claims record six months before and at least three years after the diagnosis of T2D with no history of previous neurodegenerative disease. Survival analysis was used to determine the association between A-HgM exposure and MS diagnosis. A propensity score approach was used to reduce measured and unmeasured selection bias. The analyzes were conducted from January 1 to April 28, 2021.
In T2D patients younger than 45 years, exposure to A-HgM was associated with a reduced risk of developing MS (RR: 0.22, 95% CI: 0.17–0.29, p-value <0.001). In contrast, exposure to A-HgM in patients older than 45 years was associated with an increased risk of MS, with women showing a higher risk (RR: 1.53, 95%CI: 1.39–1.69, p < 0.001) than men (RR: 1.17, 95). %CI: 1.01-1.37, p = 0·04). Patients who developed MS had a higher incidence of initial comorbidities. The mean follow-up time was 6.2 years with a standard deviation of 1.8 years.
In this study, A-HgM exposure in patients with T2D was associated with a reduced risk of MS in patients younger than 45 years, while in patients older than 45 years, A-HgM exposure was associated with an increased risk of newly diagnosed MS. MS, especially in women.