{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:39:12Z","timestamp":1787971152137,"version":"build-2784847793"},"reference-count":74,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus (T2DM) is associated with an increased risk of delirium and mortality. While glucagon\u2010like peptide\u20101 receptor agonists (GLP\u20101 RAs) provide metabolic and neuroprotective benefits, their long\u2010term impact on delirium risk remains uncertain. This study compares GLP\u20101 RAs and metformin in relation to delirium and mortality in T2DM patients using real\u2010world data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using the TriNetX global federated research network, which primarily comprises U.S.\u2010based healthcare organisations (approximately 85%), with additional sites in Europe, Asia\u2010Pacific and the Middle East. Adults (\u226518\u2009years) with T2DM who initiated GLP\u20101 RAs or metformin were included. Propensity score matching (PSM) balances baseline characteristics. The primary outcome was incident delirium; the secondary outcome was all\u2010cause mortality. Kaplan\u2013Meier survival curves and time\u2010dependent Cox models assessed associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After 1:1 PSM (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200963\u2009096 per group), GLP\u20101 RAs showed no overall reduction in delirium risk (AHR: 0.98, 95% CI: 0.94\u20131.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.3628). However, they were protective in the first 5\u2009years (AHR: 0.89, 95% CI: 0.86\u20130.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) but increased delirium risk between 5 and 10\u2009years (AHR: 1.15, 95% CI: 1.04\u20131.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0046). Subgroup analysis revealed lower delirium risk with GLP\u20101 RAs in middle\u2010aged patients (40\u201379\u2009years) and those with HbA1c &lt;7.5%. Higher risk was observed in Asian and Native Hawaiian\/Pacific Islander populations. However, these findings should be interpreted with caution due to the relatively small subgroup sizes and the limited representativeness of these groups within the predominantly U.S.\u2010based database, in which Asian and Native Hawaiian\/Pacific Islander patients together accounted for less than 5% of the overall cohort. Mortality risk was lower in absolute terms for GLP\u20101 RAs (6.28% vs. 9.95%) but higher in long\u2010term hazard (AHR: 1.16, 95% CI: 1.12\u20131.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GLP\u20101 RA use was initially associated with a lower risk of delirium, but this association reversed over time. Subgroup variations suggest individualised treatment considerations. Metformin remains a preferred option given its stable cognitive and survival benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16434","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T06:25:16Z","timestamp":1746599116000},"page":"3984-3996","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Long\u2010term delirium and survival outcomes in patients treated with\n                    <scp>GLP<\/scp>\n                    \u20101 receptor agonists versus metformin in type 2 diabetes: A population\u2010based cohort study"],"prefix":"10.1111","volume":"27","author":[{"given":"Mingyang","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine People's Hospital of Zhengzhou University, Henan Provincial People's Hospital  Zhengzhou 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