OBJECTIVE Delirium is a precursor and risk factor for dementia, emphasizing the urgency of effective prevention and management strategies in older adults with type 2 diabetes (T2D). Identifying long-term, safe, and effective medications to prevent diabetes-related delirium is crucial because of its significant impact on this population. This study aimed to evaluate the protective effects of metformin against delirium in older adults with T2D, using a competing risk analysis of death to provide a more accurate assessment. RESEARCH DESIGN AND METHODS Metformin users were compared with a cohort of nonusers. Multivariable Cox regression and Fine and Gray methods were used to assess the risk of delirium and mortality. RESULTS Our study included 66,568 metformin users and 66,568 nonusers, matched by propensity score. The use of metformin was associated with a significantly lower risk of delirium, with adjusted hazard ratios ranging from 0.77 to 0.81. A dose-response relationship was observed, indicating that higher cumulative and daily doses of metformin were associated with greater reductions in delirium risk. CONCLUSIONS Metformin use is associated with a reduced risk of delirium in older adults with T2D, with higher doses offering greater protection.

中文翻译：

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二甲双胍的使用和老年 2 型糖尿病患者发生谵妄的风险


目的 谵妄是痴呆症的先兆和危险因素，强调对患有 2 型糖尿病 (T2D) 的老年人采取有效预防和管理策略的紧迫性。确定长期、安全、有效的药物来预防糖尿病相关的谵妄至关重要，因为它对这一人群有重大影响。本研究旨在评估二甲双胍对老年 T2D 患者谵妄的保护作用，利用死亡竞争风险分析来提供更准确的评估。研究设计和方法 将二甲双胍使用者与非使用者进行比较。使用多变量 Cox 回归以及 Fine 和 Gray 方法来评估谵妄和死亡的风险。结果 我们的研究包括 66,568 名二甲双胍使用者和 66,568 名非使用者，并通过倾向评分进行匹配。使用二甲双胍可显着降低谵妄风险，调整后的风险比范围为 0.77 至 0.81。观察到剂量反应关系，表明较高的二甲双胍累积剂量和每日剂量与谵妄风险的更大降低相关。结论 使用二甲双胍可降低患有 T2D 的老年人发生谵妄的风险，较高剂量可提供更好的保护。