Among nearly 400,000 Medicare beneficiaries newly diagnosed with type 2 diabetes, those with Alzheimer's disease were significantly less likely to receive any diabetes medication, especially newer drugs like GLP-1 receptor agonists and SGLT2 inhibitors.
388,359 patients studiedwith those having Alzheimer's significantly less likely to initiate GLP-1 RAs or SGLT2 inhibitors for newly diagnosed diabetes
What the researchers found
Among 388,359 Medicare beneficiaries newly diagnosed with T2DM (9,584 with Alzheimer's), overall treatment initiation within one year was lower for individuals with AD. Those with AD who did start treatment were more likely to receive insulin and less likely to receive metformin, SGLT2 inhibitors, or GLP-1 receptor agonists.
In adjusted models, Alzheimer's disease was associated with lower odds of any antidiabetic treatment initiation and, among those who started treatment, lower odds of initiating newer agents like GLP-1 RAs and SGLT2 inhibitors. The findings reveal a treatment disparity that may have clinical consequences given emerging evidence of cardiovascular and neuroprotective benefits of these newer drug classes.
Why it matters
GLP-1 receptor agonists and SGLT2 inhibitors offer cardiovascular protection and potential neuroprotective benefits that could be especially valuable for Alzheimer's patients. The finding that this population is disproportionately excluded from these newer therapies — possibly due to complexity of care, perceived life expectancy, or prescriber caution — highlights a potential treatment gap that deserves clinical attention.
How the study worked
Retrospective cohort study using 20% Medicare Fee-for-Service claims data from 2016 to 2020. The primary outcome was initiation of any antidiabetic medication within one year of new T2DM diagnosis. The researchers examined initiation patterns across specific drug classes and used multivariable logistic regression to estimate adjusted odds ratios for the association between Alzheimer's status and treatment patterns.
What this study cannot tell us
Claims data cannot capture the clinical reasoning behind prescribing decisions — physicians may have valid reasons for choosing insulin over newer agents in patients with cognitive impairment (e.g., injection simplicity with caregiver support, concerns about GI side effects). The study cannot determine whether the treatment differences led to different clinical outcomes. The data spans 2016-2020, before the most recent expansion of GLP-1 RA use.
How to read the evidence
This is a large retrospective cohort study using national Medicare claims data with multivariable adjustment. While it provides strong observational evidence of treatment disparities, it cannot establish causation or capture the clinical reasoning behind prescribing decisions.
When this study was published
Published in 2026 using 2016-2020 Medicare data, this study reflects treatment patterns before the most recent surge in GLP-1 RA prescribing. Current patterns may differ, though the underlying disparity may persist.
The bigger picture
This study intersects diabetes management, dementia care, and health equity. As GLP-1 receptor agonists are increasingly recognized for potential benefits beyond blood sugar control — including cardiovascular protection and possible neuroprotective effects — the finding that Alzheimer's patients are systematically underrepresented among recipients of these drugs is particularly significant. It raises broader questions about therapeutic nihilism in dementia care.
Questions still open
- Would GLP-1 receptor agonists' potential neuroprotective effects particularly benefit patients with both diabetes and Alzheimer's?
- Are the prescribing differences driven by clinical appropriateness concerns, ageism, or systemic barriers?
- How have prescribing patterns changed since 2020 given the explosive growth of GLP-1 RA awareness?
Common questions
Why might doctors prescribe different diabetes drugs to Alzheimer's patients?
Could GLP-1 drugs help Alzheimer's patients beyond blood sugar control?
Read the original research
Treatment of type 2 diabetes among medicare beneficiaries with and without alzheimer's disease: A retrospective cohort study.
Journal of diabetes and metabolic disorders, 25(1), 25
Citation
Wang, Yingqi; Alexander, G Caleb; Mehta, Hemalkumar B. (2026). Treatment of type 2 diabetes among medicare beneficiaries with and without alzheimer's disease: A retrospective cohort study.. Journal of diabetes and metabolic disorders, 25(1), 25. https://doi.org/10.1007/s40200-025-01838-8