{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:52:26Z","timestamp":1790808746651,"version":"4.1.0"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Prior studies suggested that metformin may be associated with reduced dementia incidence, but associations may be confounded by disease severity and prescribing trends. Cessation of metformin therapy in people with diabetes typically occurs due to signs of kidney dysfunction but sometimes is due to less serious adverse effects associated with metformin.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the association of terminating metformin treatment for reasons unrelated to kidney dysfunction with dementia incidence.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study was conducted at Kaiser Permanente Northern California, a large integrated health care delivery system, among a cohort of metformin users born prior to 1955 without history of diagnosed kidney disease at metformin initiation. Dementia follow-up began with the implementation of electronic health records in 1996 and continued to 2020. Data were analyzed from November 2021 through September 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n A total of 12\u202f220 early terminators, individuals who stopped metformin with normal estimated glomerular filtration rate (eGFR), were compared with routine metformin users, who had not yet terminated metformin treatment or had terminated (with or without restarting) after their first abnormal eGFR measurement. Early terminators were matched with routine users of the same age and gender who had diabetes for the same duration.<\/jats:p>\n <\/jats:sec>\n \n Main outcomes and measures<\/jats:title>\n \n The outcome of interest was all-cause incident dementia. Follow-up for early terminators and their matched routine users was started at age of termination for the early terminator. Survival models adjusted for sociodemographic characteristics and comorbidities at the time of metformin termination (or matched age). Mediation models with HbA\n 1c<\/jats:sub>\n level and insulin usage 1 and 5 years after termination tested whether changes in blood glucose or insulin usage explained associations between early termination of metformin and dementia incidence.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The final analytic sample consisted of 12\u202f220 early terminators (5640 women [46.2%]; mean [SD] age at start of first metformin prescription, 59.4 [9.0] years) and 29\u202f126 routine users (13\u202f582 women [46.6%]; mean [SD] age at start of first metformin prescription, 61.1 [8.9] years). Early terminators had 1.21 times the hazard of dementia diagnosis compared with routine users (hazard ratio, 1.21; 95% CI, 1.12 to 1.30). In mediation analysis, contributions to this association by changes in HbA\n 1c<\/jats:sub>\n level or insulin use ranged from no contribution (0.00 years; 95% CI, \u22120.02 to 0.02 years) for insulin use at 5 years after termination to 0.07 years (95% CI, 0.02 to 0.13 years) for HbA\n 1c<\/jats:sub>\n level at 1 year after termination, suggesting that the association was largely independent of changes in HbA\n 1c<\/jats:sub>\n level and insulin usage.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, terminating metformin treatment was associated with increased dementia incidence. This finding may have important implications for clinical treatment of adults with diabetes and provides additional evidence that metformin is associated with reduced dementia risk.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.39723","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T11:34:02Z","timestamp":1698233642000},"page":"e2339723","source":"Crossref","is-referenced-by-count":29,"title":["Metformin Cessation and Dementia Incidence"],"prefix":"10.1001","volume":"6","author":[{"given":"Scott C.","family":"Zimmerman","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Statistics, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin L.","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Statistics, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhu","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilrini K.","family":"Ranatunga","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research, Oakland, California"},{"name":"Now with Kaiser Permanente Research Bank, Oakland, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinyemi","family":"Oni-Orisan","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Hayes-Larson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"Duarte Folle","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Rose","family":"Mayeda","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel A.","family":"Whitmer","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research, Oakland, California"},{"name":"Department of Public Health Sciences, University of California, Davis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Gilsanz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Statistics, University of California, San Francisco"},{"name":"Kaiser Permanente Division of Research, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda C.","family":"Power","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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