The impact of sodium-glucose cotransporter 2 inhibitors (SLGT2i) usage on reducing the risk of dementia remains uncertain. Our research seeks to establish

Aims: Evidence showed that SGLT2 inhibitors have greater protective effects against retinal diseases compared to other hypoglycemic agents. Thus, we explore the association between SGLT2 inhibitor usage and macular degeneration (MD) in Taiwanese patients with diabetes. Methods: The National Health Insurance (NHI) program's claim data are released as the National Health Insurance Research Database (NHIRD). This database covers more than 99% of the residents in Taiwan. We included data on patients who were newly diagnosed with type 2 diabetes mellitus (ICD-9-CM: 250, exclude 250.1x; ICD-10-CM: E11), with an age at diagnosis of over 20 years as our study population. Patients who received (sodium-glucose cotransporter 2 inhibitor) SGLT2i (ATC code: A10BK) over 90 days in 2016–2019 were defined as the SGLT2i cohort. Conversely, patients who did never received SGLT2i were defined as the non-SGLT2i cohort. The exclusion criteria were having MD before the index date, receiving SGLT2i within 1–89 days, and missing data on sex, age, or days of SGLT2i usage. Two cohorts were matched by 1:1 propensity score matching, which was based on age, sex, payroll bracket grade, urbanization, comorbidities, and medications. Results: Compared to non-SGLT2i cohort, patients who received SGLT2i had a significantly lower risk of MD (adjusted hazard ratio = 0.70, 95%CI = 0.66–0.75). Conclusions: We found that SGLT2is has a strong protective effect against MD in patients with diabetes. SGLT2is may have benefits beyond glycemic control in patients with DR. However, additional clinical and experimental studies are required.

Purpose Type 2 diabetes mellitus (T2DM) is associated with elevated risks of osteoporosis and fractures, but the contribution of diabetic microvascular complications remains poorly defined—especially in Asian populations. Prior studies have suggested links between diabetes-related complications and skeletal fragility, but most were limited by small sample sizes, cross-sectional designs, or inadequate adjustment for key confounders such as medication use, fall history, and comorbidities. Methods Using Taiwan’s National Health Insurance Research Database, we conducted a large-scale, population-based cohort study of individuals newly diagnosed with T2DM (2008–2020) to assess associations between microvascular complications and the risk of new-onset osteoporosis and osteoporotic fractures using multivariable Cox proportional hazards models. Results In this East Asian cohort, patients with diabetic neuropathy (DN), retinopathy (DR), or kidney disease (DKD) exhibited a graded increase in the risk of both osteoporosis and major osteoporotic fractures, including those of the hip, spine, humerus, and radius/ulna. Compared to patients without microvascular disease, those with DR and DN had significantly higher risks of osteoporosis (adjusted hazard ratio [aHR]: 1.14 [95% CI: 1.09–1.19] and 1.25 [1.22–1.28], respectively; p < 0.001). Furthermore, amongst the microvascular complications, DN showed the strongest and most consistent associations with osteoporosis and spine fractures. Conclusions This nationwide cohort focused exclusively on newly diagnosed T2DM patients and comprehensively adjusted for confounders. Our findings suggest that microvascular complications may serve as independent predictors of skeletal fragility and support their incorporation into fracture risk assessment models, particularly for Asian individuals with T2DM.

Adjuvant XELOX (capecitabine plus oxaliplatin) and TS-1 (S-1) monotherapy are both guideline-recommended following D2 gastrectomy for gastric cancer, yet head-to-head real-world data exclusively in stage III disease remain scarce. Using Taiwan’s National Health Insurance Research Database linked to the Taiwan Cancer Registry–Long Form, we identified stage III gastric cancer patients who underwent D2 gastrectomy (2010–2019) and received adjuvant XELOX or TS-1 for ≥3 months. Propensity score matching balanced chemotherapy and non-chemotherapy cohorts (1706/group). Overall survival (OS) was the primary endpoint; disease progression was defined as initiation of FOLFOX salvage chemotherapy (used as a pragmatic proxy for disease recurrence). A second propensity score matching was performed directly between XELOX (n = 533) and TS-1 (n = 893) groups, yielding 490 matched pairs with well-balanced baseline characteristics. Multivariable Cox regression was adjusted for sex, age, comorbidities, and Charlson Comorbidity Index. TS-1 was associated with significantly better OS (adjusted HR 0.73, 95% CI 0.61–0.86; p < 0.001) and lower progression (adjusted HR 0.38, 95% CI 0.23–0.62; p < 0.001) versus XELOX; the corresponding 3-year OS was approximately 65.4% for TS-1 versus 56.8% for XELOX, and extrapolated 5-year OS approximately 50.2% versus 41.7%, respectively (note: these 5-year estimates are Kaplan–Meier projections beyond the mean follow-up of ~2.6 years and carry substantial uncertainty; they should be interpreted with caution). Benefits were confined to stage IIIA (OS HR 0.64, 95% CI 0.45–0.89; p = 0.009; interaction p = 0.006; progression HR 0.29, 95% CI 0.11–0.76; p = 0.011), with comparable outcomes in IIIB and IIIC. Adjuvant TS-1 monotherapy was associated with superior OS and lower disease progression versus XELOX in stage III gastric cancer, particularly in stage IIIA; these findings are hypothesis-generating and warrant confirmation in prospective randomized trials, whereas in stage IIIB/IIIC outcomes were comparable between the two regimens.