Prandin Offers Advantages in Elderly Diabetics

Fifty-one percent risk reduction for hypoglycemia over glyburide in elderly patients with type 2 or non-insulin dependent diabetes, treatment with the short-acting drug repaglinide (Prandin/NovoNorm).. In particular, there are far fewer episodes of low blood sugar, what doctors call hypoglycemia, with Prandin/NovoNorm, they found.

"The major clinical implication of our study," said Dr. Francesco Purrello, "is that short-acting hypoglycemic drugs, such as repaglinide, should be used in elderly individuals instead of long-acting compounds, such as glyburide, to decrease the risk of hypoglycemic reactions that may be extremely dangerous in these patients."

According to Purrello, "despite the disproportionate number of elderly individuals with diabetes mellitus, the treatment of these patients is often inadequate and the therapeutic goals undefined, mainly because of the fear of severe hypoglycemic events."
"The reverse side of the coin," he added, "is that, also in elderly patients, poor metabolic control increases the risk of cardiovascular disease and stroke."

To determine whether a short-acting agent might be safer than a long-acting one, the researchers conducted a 24-week crossover study of 90 diabetic patients aged 65 years or older.

They were randomized to take Prandin/NovoNorm at mealtime or twice-daily glibenclamide. The frequency of low blood sugar episodes was significantly lower with Prandin/NovoNorm than with glibenclamide, at 0.38 versus 1.4 episodes per 12-week period per patient.

This, say the investigators, amounted to a 51 percent risk reduction. Results were similar in a subgroup of patients aged 75 years or older.

"The major clinical implication of our study," concluded Dr. Purrello, "is that short-acting hypoglycemic drugs, such as repaglinide, should be used in elderly individuals instead of long-acting compounds, such as glyburide, to decrease the risk of hypoglycemic reactions that may be extremely dangerous in these patients."

Diabetes Care August 2006.

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DID YOU KNOW:
Rosiglitazone Component of Avandamet Contraindicated in NYHA Class 3/4 Patients: The FDA approved safety labeling revisions for metformin HCl plus rosiglitazone maleate tablets, warning against its use in patients with New York Heart Association (NYHA) class 3 and 4 cardiac status. The combination therapy has not been studied in this population. As with other thiazolidinediones, rosiglitazone is associated with a risk for fluid retention that may exacerbate or lead to heart failure. Patients receiving rosiglitazone should be observed for signs and symptoms of heart failure, and therapy should be discontinued if any deterioration in cardiac status occurs.