Sitagliptin (Januvia, MSD) provides similar glycaemic improvement but with less hypoglycaemia compared to sulphonylurea (SU) treatment in elderly patients with type 2 diabetes, show results reported at the European Association for the Study of Diabetes (EASD) annual meeting (1-5 October 2012; Berlin, Germany).

Researchers carried out a post-hoc analysis pooling data from three double-blind clinical studies for patients with type 2 diabetes aged 65 and older treated with sitagliptin (100mg/day) or a sulphonylurea (glipizide or glimepiride in titrated doses). They compared blood glucose reductions and rates of hypoglycaemia with the two treatments.

Results showed that elderly patients taking sitagliptin (n=178) achieved the same reduction in mean HbA1c – 7.5% from baseline – as patients taking a sulphonylurea (n=195; mean HbA1c reduction 7.5%). But four times as many patients on an SU experienced one or more episodes of symptomatic hypoglycaemia (28.2%) than those on sitagliptin (6.2%).

“The general effects of aging complicate the treatment of diabetes in the elderly. In particular, hypoglycaemia is of greater concern in this population and may lead to dizziness and accidents or falls, which are more likely to be dangerous in the elderly,” said Dr Barry Goldstein, Therapeutic Area Head in Diabetes and Endocrinology with Merck Research Laboratories. “Therefore, careful consideration of treatment options for older patients is important,” he added.

The recent EASD/ADA consensus on the treatment of type 2 diabetes recommends much greater individualisation of therapy than in the past, focusing on each patient’s individual risk factors, characteristics and preferences.

“The overarching goal should be to reduce blood glucose concentrations safely to a range that will substantially minimise long-term complications, but, always keeping in mind the potential adversities with treatment burden, particularly in the elderly who are more often exposed to multiple drug treatments,” EASD president Professor Andrew Boulton told a special session of the meeting on the new consensus.

Susan Mayor PhD, freelance medical journalist, London, UK