medwireNews: Sitagliptin has a neutral cardiovascular effect in patients aged 75 years or older with type 2 diabetes and provides significant glycemic benefits, shows further analysis of the TECOS participants.
TECOS included 2004 patients who were at least 75 years of age, and 582 of these were aged 80 years or older. They had a shorter duration of treatment than the 12,347 younger patients, because of a higher rate of drug discontinuation, at 36.6% versus 24.1%.
Most adverse outcomes occurred at a significantly higher rate in the older than younger patients, but this was unaffected by whether they were randomly assigned to receive sitagliptin or placebo. Among older patients, the trial’s primary composite cardiovascular outcome – of cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, or hospitalization for unstable angina – occurred in 17.5% of the sitagliptin group and in 16.2% of the placebo group, which was a nonsignificant difference.
There were also no significant increases in rates of hospitalization for heart failure, all-cause mortality, or any nonvascular adverse events among older patients taking sitagliptin, report M Angelyn Bethel (University of Oxford, UK) and co-workers.
“The importance of evaluating antihyperglycemic medications to treat type 2 diabetes in older patients should not be underestimated,” the researchers write in Diabetes Care. “With increasing longevity, the proportion of older people requiring treatment for type 2 diabetes is rising.”
However, they caution that the TECOS patient population may not be representative of the overall population of older patients with diabetes, which is heterogeneous and includes patients in care homes.
“Although TECOS did not measure frailty or functional status, it is reasonable to assume that most patients enrolled were ambulatory and reasonably functional since clinic visits every 6 months and the ability to see their usual care doctor at least twice yearly were requirements of the trial design,” they note.
Glycated hemoglobin levels were slightly but significantly lower in older than younger patients throughout the study, by an absolute difference of 0.11%. And among older patients, there was a significant absolute reduction of 0.30% for those taking sitagliptin versus placebo.
“Although these results cannot exclude the possibility of other benefits or risks emerging over a longer follow-up period, especially in patients with increasingly complex comorbidities, they are reassuring for practitioners managing an aging population with diabetes,” concludes the team.
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