A large real-world study published in Diabetes Care has found that sodium-glucose cotransporter 2 inhibitors (SGLT2is) may offer better protection against delirium than metformin in individuals with type 2 diabetes (T2D). The study analyzed the data of 850,000 adults.

The retrospective cohort study included patients with T2D who began treatment with either SGLT2is (88,012 patients) or metformin (769,159 patients) between 2005 and 2025. After balancing baseline characteristics using 1:1 propensity score matching, researchers compared outcomes between the two drug groups.

SGLT2i users had a significantly lower incidence of delirium compared with  metformin (3.97% versus 9.0%), resulting in an absolute risk reduction of 5.03%. The adjusted hazard ratio (aHR) for delirium in the SGLT2i group was 0.91, indicating a 9% risk reduction. SGLT2 inhibitors were also associated with a reduction in all-cause mortality (ARR 9.23%, aHR 0.85).

The most significant benefits were reported in patients aged 80 years or older, in men, and in those considered high-risk due to concurrent insulin or sedative use.