The tolerability and safety of DPP-4 inhibitors for the treatment of older people with type 2 diabetes mellitus: an observational study

Abstract

Aims/introduction: Despite type 2 diabetes mellitus being up to five times more prevalent in patients aged ≥65 years compared with patients <65 years of age, this population is surprisingly less well studied. Dipeptidyl peptidase (DPP)-4 inhibitor treatment is an option for this older patient group, but clinical practice data for this drug class are sparse in this population. The study examined the efficacy and tolerability of DPP-4 inhibitors in older patients with type 2 diabetes whilst focusing on particular pertinent aspects relevant to care of older persons. Materials and methods: The medical records of 431 randomly selected patients (median age 74 years) were reviewed and two cohorts (DPP-4-inhibitor-treated and non-DPP-4-inhibitors-treated) were compared. Results: Both groups had a similar duration of diabetes (8 years) and comparable glycated haemoglobin A1C concentrations (7.4% and 7.2%). Hypoglycaemia was less common in the DPP-4 inhibitor group (3%) compared with the medically treated non-DPP-4 inhibitor group (8%), p<0.02. Despite significantly more patients in the non-DPP-4 inhibitor group living in cared accommodation (9% vs. 2%) this group received significantly more insulin (30% vs. 7%). Conclusion: Clinicians need to consider the specific clinical issues relevant to older diabetic patients when taking complex treatment decisions.

Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing

“… P: 100 P ≥ 65 years: 98 P using DPP-4 inhibitors: 26 P using other antidiabetic agents: 72 Not reported Acute ischemic stroke severity measured with the modified Rankin Scale score at discharge and with in-hospital mortality. Viljoen et al 2013 [ 46 ] (Search 3B) Observational study To study the efficacy and tolerability of DPP-4 inhibitors in older patients with type 2 diabetes whilst focusing on particular pertinent aspects relevant to care of older persons. P: 431 P ≥ 65 years: 431 P using DPP-4 inhibitors: 129 P never treated with DPP-4 inhibitors: 302 Not reported Hypoglycaemia.…”

“…Nine observational studies compared patients treated with DPP-4 inhibitors with patients not receiving DPP-4 inhibitors [ 46 ]; other antidiabetic drugs [ 33 , 35 , 45 , 49 , 51 ]; or between cases and controls [ 36 , 47 , 48 ]. These studies reported on the following outcomes: hypoglycaemia, fractures, disability after stroke (with the modified Rankin scale), cardiovascular events, hospitalisation for heart failure, hospitalisation for sepsis, and mortality.…”

“…Hypoglycaemia was defined by 3 studies as hypoglycaemic symptoms confirmed by self-monitoring of blood glucose <3.1 mmol/l [ 29 , 40 , 52 ]; another study defined symptomatic hypoglycaemia as an episode with clinical symptoms without regard to glucose level, asymptomatic hypoglycaemia was defined as an episode of glucose level ≤ 70 mg/dL without symptoms [ 37 ]; another study defined confirmed hypoglycaemia as a symptomatic or asymptomatic event with plasma glucose <3.0 mmol/l without requiring external assistance, severe hypoglycaemia was defined as symptomatic event requiring external assistance without regard to plasma glucose level [ 39 ]; the other 3 studies did not provide a definition of hypoglycaemia. In 10 studies [ 37 , 39 , 40 , 46 , 49 , 50 , 53 – 55 , 59 ] hypoglycaemia was considerably less frequent in older people treated with DPP-4 inhibitors than in older people on other treatments, on placebo, or when used as an additional medication.…”

“…Quality appraisal of the 12 observational studies is shown in Table 5 . Six studies reported insufficiently on most of the CASP items to be considered of high quality [ 36 , 46 , 49 , 50 , 57 ]. The other six studies reported information on most of the CASP items to be considered of high quality [ 33 – 35 , 45 , 47 , 48 ].…”

Clinical characteristics and outcomes of the oldest old people with type 2 diabetes – perspective from a tertiary diabetes center in Thailand

“…In our study, we also found that DPP-4 inhibitors were prescribed as the second most common drugs for the oldest old patients. A recent retrospective study on DDP-4 inhibitors prescribed to elderly diabetes patients (median age 70 years, range 60–92 years) found that median A1C improved from 8.3 to 7.4 % and DDP-4 inhibitors treated patients had a lower rate of documented hypoglycemia than the non-DPP-4 inhibitors treated group (3 vs. 8 %) [ 22 ]. Therefore, DPP-4 inhibitors would be an attractive choice for oldest old patients for its lower rate of hypoglycemia and neutral weight effects.…”