SGLT2 Inhibitors Linked to Reduced Delirium Risk in Type 2 Diabetes Patients

A recent study reveals that the use of Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors may significantly lower the risks of delirium and all-cause mortality in adults diagnosed with type 2 diabetes (T2D). The findings, published on June 12, 2025, in the journal Diabetes Care, indicate that SGLT2 inhibitors offer superior neuroprotective benefits compared to traditional metformin therapy, particularly among older patients and those with better glycemic control.

The study, conducted by researchers from the Department of Anesthesiology and Perioperative Medicine at People’s Hospital of Zhengzhou University, involved a retrospective cohort analysis that included 79,723 adults aged 65 years and older who were prescribed either SGLT2 inhibitors or metformin from January 2005 to January 2025. The primary focus was to compare the incidence of delirium and overall mortality rates.

According to Dr. Mingyang Sun, the lead author of the study, "By leveraging real-world data on an unprecedented scale, this study not only bridges a critical knowledge gap but also paves the way for a paradigm shift in first-line diabetes management, prioritizing both metabolic and neurocognitive health."

The findings showed that patients using SGLT2 inhibitors had a 9% lower risk of developing delirium (adjusted hazard ratio [aHR] of 0.91; 95% CI, 0.87-0.95) compared to those on metformin. Additionally, all-cause mortality was reduced by 15% in the SGLT2 group (aHR, 0.85; 95% CI, 0.87-0.88). The protective effects were particularly pronounced in patients aged 80 years or older, with an aHR of 0.83 (P < .0001), and among those with better glycemic control.

Despite these promising results, the study is not without limitations. The reliance on diagnostic codes could lead to an underestimation of delirium cases, particularly those that are milder and managed outside hospital settings. Moreover, the absence of neurocognitive markers limited the researchers’ ability to fully understand the neuroprotective effects of SGLT2 inhibitors.

The implications of these findings are significant for clinical practice. Experts suggest that the results may encourage healthcare providers to reconsider first-line treatment options for T2D, especially in high-risk populations. Dr. Sarah Thompson, an endocrinologist at the Mayo Clinic, emphasized, "The neuroprotective effects of SGLT2 inhibitors could fundamentally alter how we approach diabetes management, particularly in older adults who are at greater risk for cognitive decline."

Furthermore, the study highlights the broader context of diabetes care, which increasingly recognizes the importance of neurocognitive outcomes alongside traditional metabolic measures. The integration of neuroprotective strategies in diabetes management could ultimately improve quality of life and reduce healthcare costs associated with complications such as delirium.

Looking forward, further research is needed to explore the full range of benefits and potential side effects associated with SGLT2 inhibitors. As the healthcare landscape continues to evolve, the findings of this study may serve as a catalyst for enhanced treatment protocols aimed at addressing both the physiological and cognitive aspects of diabetes care.

In conclusion, the recent study underscores the potential of SGLT2 inhibitors in protecting against delirium and reducing mortality in patients with T2D, offering a promising avenue for future research and clinical practice changes. This shift towards prioritizing neurocognitive health in diabetes management may lead to improved patient outcomes and a more holistic approach to treatment.