Sitagliptin yielded similar glycemic results as sulfonylureas, but with less hypoglycemia and improvements in body weight among elderly patients with type 2 diabetes….
According to researchers, these data demonstrate that sitagliptin is an effective and well-tolerated treatment for patients aged at least 65 years.
Ravi R. Shankar, MD, associate director of Clinical Research-Diabetes and Endocrinology at Merck, and colleagues wrote in their abstract that, “In the US, 45% of patients with type 2 diabetes are elderly (≥65 years old), a group that presents unique therapeutic challenges due to comorbidities.” “Sulfonylurea use is associated with greater risk for hypoglycemia in the elderly and its use increases with age.”
To compare the effect of the DPP-4 inhibitor sitagliptin (Januvia, Merck) with sulfonylureas on change in HbA1c, fasting plasma glucose, body weight and incidence of symptomatic hypoglycemia, Shankar and colleagues conducted a post-hoc analysis. The researchers pooled data from three double blind studies that included patients aged ≥65 years.
Patients were treated by diet alone or metformin and were randomly assigned to sitagliptin or glipizide (Glucotrol, Pfizer) for 104 weeks or glimepiride (Amaryl, Sanofi-Aventis) for 30 weeks. There were 373 patients who completed trials through 30 weeks, they wrote.
Both HbA1c and fasting plasma glucose decreased with sitagliptin and the sulfonylureas, with no statistically significant difference between treatments. However, sitagliptin was associated with a significantly lower incidence of hypoglycemia and a larger decline in body weight.
“Significantly more patients on sitagliptin than sulfonylurea achieved the composite endpoint of .0.5% A1c reduction with no hypoglycemia or body weight gain at 30 weeks,” they wrote. “In conclusion, sitagliptin provided similar glycemic efficacy, with less hypoglycemia and with body weight loss compared to sulfonylurea in elderly patients, suggesting that sitagliptin is an effective and well-tolerated treatment option for patients ≥65 years with type 2 diabetes mellitus.”
Shankar R. Abstract #1077-P. Presented at: the American Diabetes Association’s 72nd Scientific Sessions; June 8-12, 2012; Philadelphia.