Quick answer: New research suggests GLP-1 and SGLT2 diabetes drugs may lower dementia risk, though it isn’t yet clear whether this is via weight loss, better blood sugar control, or something else. What is clear is that consistency — in medication, but also in everyday habits like meditation — matters more than any single big effort.
Every time I look at a medical journal these days it seems there are more trials and studies coming out about weight loss drugs, but not necessarily about the weight loss itself. An issue however, is that without large randomised controlled trials, it can be hard to make definitive conclusions. We know for sure from such trials now that GLP-1 agonist drugs (the medical name) reduce weight, can reduce the risk of heart attack and stroke in overweight people, and have beneficial effects in patients with heart failure, dramatically improving symptoms of breathlessness. I’d really like to know a bit more about why this is the case. Obviously it’s great that they work, but the scientist in me wants to know more.
What does the evidence show?
The latest paper I have read in this space suggests a reduction in dementia risk in diabetic people who are on both these drugs, and a type of sugar-lowering medication called SGLT2-inhibitors (as an aside, I would estimate I have prescribed more of these than any other medication in the last 12 months – they are great for all forms of heart failure). So is the dementia lowering effect due to lower sugar levels and better diabetic control? Is it due to weight loss? We know being overweight is a big risk factor for developing dementia. Is it something else? The truth is no-one knows at this point.
The fact that diseases such as dementia and heart disease typically take so long to develop doesn’t help investigators! What I would really like to see is a comparison trial between those medications and a really good lifestyle – is there any benefit over and above all the really boring, but really effective stuff that I’m always droning on about?
A lesson in consistency
Speaking of lifestyle measures, there’s one area of my own life which I need to improve upon. This morning I dropped my son off to take a train. There was a queue at the kiosk to buy a ticket. No problem, I thought, I’ll use the machine. Have you ever tried to buy a child ticket without an adult ticket at a station machine? My advice is don’t. Long story short, he missed the train by 30 seconds because I could get the ****** machine to sell me a child-only ticket. I’m writing this on a train to London, a train I also missed, this time by 90 seconds, because of lots of traffic on the way to the station.
I tried to be mindful and not upset, then a minute after leaving the car, my water bottle fell out of my rucksack and smashed on the floor. After buying some more water from a supermarket, I reflected that these events really shouldn’t have got to me, but I let them. I think the reason why is I’ve been a bit slack on my meditation practice in recent weeks. I’ve been feeling really good mentally, and I think the temptation to skip it here and there if I’m busy has been too strong. I still do it, but probably a couple of times a week instead of daily. Today has taught me a lesson. I am someone who needs that regular meditation practice, even if, and maybe especially if, I’m feeling well. I don’t want to be de-railed by life’s little challenges like missing two trains and a smashed water bottle! I expect you have had days like this, and how have you coped? If you’ve never tried meditation, I would encourage you to give it a try. I was a total sceptic but it’s been amazing for me. There are loads of apps out there to learn from.
The principal is much like regular exercise, nutrition and sleep. Doing these things really well routinely pays enormous dividends, but you have to do them regularly, even when you feel well.