Metformin vs. second-line therapy for delirium prevention in type 2 diabetes: A multinational study
Main finding · DeliriumResult — go to the resultAdjusted hazard ratio 0.86 95% CI 0.83–0.89Authors' conclusion
In this large-scale study, metformin use was associated with reduced delirium and mortality risk compared to DPP-4i, reinforcing its role as the preferred first-line T2DM therapy, especially in patients at risk for neurocognitive decline.
Study context
- Population
- Patients with T2D, TriNetX network84,221 per group matched
- Participants
- 860,388 patients
- Exposure
- Metformin vs DPP-4i
- Metforminn = 84,221
- DPP-4in = 84,221reference
- Outcome
- Delirium incidence
Methodological detailspropensity score matching, TriNetX network
- Propensity score matching
- TriNetX network
Main finding
Delirium
Adjusted hazard ratio
0.86
95% CI 0.83–0.89
Metforminvs DPP-4i
aHR 0.86 (95% CI 0.83–0.89)
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aHR (95% CI) | |
|---|---|---|
| All-cause mortality | 0.76 (0.74–0.78) | |
| 0.512Adjusted hazard ratio (log scale) |
Delirium by subgroup (age, sex, glycemic control)
- Consistent delirium risk reduction across age, sex and glycemic control
Sensitivity analyses (competing risks)
- Sensitivity analyses upheld the effect, mitigating survival bias concerns
Original publication
Metformin vs. second-line therapy for delirium prevention in type 2 diabetes: A multinational study. Diabetes Res Clin Pract. Published 20 May 2025. doi:10.
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