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DPP-4 Inhibitors and Type 2 Elderly Patients

In a study, older patients taking Januvia reduced their A1c’s without an increased risk of hypoglycemia….

The mortality rate for elderly individuals with type 2 diabetes is twice that of elderly individuals without type 2 diabetes. That is why it is very important for elderly individuals with diabetes to optimize their drug therapies, eat healthily, and exercise consistently to help control their blood glucose levels and prevent hypoglycemia. Hypoglycemia is always a concern when it comes to treating diabetes, but it is more of a concern with the elderly because their ability to identify hypoglycemia as compared to younger adults has diminished. As a result, it is harder to control blood glucose levels in the elderly. Treatment regimens have to be cautiously prescribed due to the increased risk of hypoglycemia.

Januvia is a dipeptidyl peptidase-4 inhibitor that is weight-neutral and has a decreased risk of hypoglycemia. Researchers reviewed the efficacy and safety of Januvia use by elderly type 2 diabetics via a post-hoc age-stratified analysis; study participants received Januvia over a 2-year time frame.

There were 831 elderly type 2 diabetics participating, all of whom were taking Januvia. Researchers looked at age, hemoglobin A1C, body weight, serum creatinine, and adverse events. The participants were divided into three groups based on their age: 1) less than 65 years old, 2) between 65 and 74 years old, and 3) 75 years old or older. Measures of safety and efficacy were predicated on hemoglobin A1C, after-meal blood glucose levels, body weight, serum creatinine, estimated glomerular filtration rate, and adverse events. An analysis of variance was used to determine if there were any significant variations among the groups (p<0.05).

There was a significant decrease in hemoglobin A1C in all age groups. Individuals who were under the age of 65 went from a hemoglobin A1C of 8.1 (+/- 1.2%) to 7.4 (+/- 1%) after 1 year and 7.3 (+/- 0.9%) after 2 years of being on Januvia. Individuals in the 65 to 74- year-old group went from a hemoglobin A1C of 7.6 (+/- 0.9%) to 7.0 (+/- 0.7%) after 1 year and 7.0 (+/- 0.7%) after 2 years. And finally, individuals 75 years of age or older went from a hemoglobin A1C of 7.7 (+/- 0.9%) to 7.1 (+/- 0.7%) after 1 year and 7.1 (+/- 1.1%) after 2 years. Changes in weight were not significant in any age group. There was a significant decrease in both fasting and after-meal blood glucose levels in all age groups at 1 year and 2 years. Serum creatinine was significantly increased in all age groups at 2 years. Reports of adverse events included hypoglycemia (n=58), rash (n=5), constipation (n=8), edema (n=2), diarrhea (n=2), and nausea (n=2).

This study showed that elderly individuals with type 2 diabetes, even those over the age of 75, can effectively reduce their hemoglobin A1C with Januvia without an increased risk of hypoglycemia.

Practice Pearls:

  • Januvia can be safely used to effectively lower the hemoglobin A1C in elderly type 2 diabetics.
  • Elderly type 2 diabetics over the age of 75 were not at an increased risk for hypoglycemia while using Januvia.
  • Better control of hypoglycemia in elderly type 2 diabetics may help to reduce the mortality rate associated with this group.

Umezawa S, Kubota A, Maeda H, et al. “Two-year assessment of the efficacy and safety of sitagliptin in elderly patients with type 2 diabetes: Post hoc analysis of the ASSET-K study.” BMC Endocrine Disorders 15.34 (2015): n. pag. Web. 7 July 2015.