Tuesday , November 21 2017
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DPP-4 Inhibitors in the Elderly

Tolerability in type 2 diabetes patients aged 65 years and older…. 

A recent observational study focused on the safety and tolerability of the DPP-4 (dipeptidylpeptidase-4) inhibitors in the treatment of type 2 diabetics aged 65 years and older. Researchers reviewed the medical records of patients with type 2 diabetes aged over 65 years (N=431, mean age of 74 years). Individuals were divided into two groups: those taking DPP-4 inhibitors and those taking non-DPP-4 inhibitor diabetes medications.

Both groups had similar HbA1c levels. Differences between groups included less mild hypoglycemia among those taking DPP-4 inhibitors as compared to those taking non-DPP-4 inhibitors (3% vs. 8%, p=0.062). Additionally, patients on DPP-4 inhibitors showed a reduction in HbA1c from approximately 8.3% to 7.4%, consistent with previous literature. Among patients receiving DPP-4 inhibitors identified in this study, most patients were taking sitagliptin (74.3%), followed by vildagliptin (21.8%) and saxagliptin (3.9%).

The authors concluded that clinicians should consider individual patient needs and emphasize individualized treatment plans in order to ensure the optimal balance of patient risk reduction and safety.

Limitations of the study include the retrospective nature of the analysis and the possibility for under-reporting of hypoglycemic events as documented by medical records. Additionally, the use of other non-DPP-4 inhibitor agents such as sulfonylureas, metformin, and insulin, were varied between groups.

Practice Pearls:
  • There may be fewer instances of mild hypoglycemia among individuals with type 2 diabetes aged 65 yrs and older taking DPP-4 inhibitors as compared to those taking non-DPP-4 inhibitors.
  • Patients aged 65 years and older taking DPP-4 inhibitors showed a reduction in HbA1c from approximately 8.3% to 7.4%.
  • Practitioners should consider individual patient needs and emphasize individualized treatment plans to ensure the best balance of patient risk reduction and safety. 

[Viljoen et al. The tolerability and safety of DPP-4 inhibitors for the treatment of older people with type 2 diabetes mellitus: an observational study. The British Journal of Diabetes & Vascular Disease. 2013;13(4):187-191]