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Diabetes Care. 2007 Dec;30(12):3017-22. Epub 2007 Sep 18.

Management of type 2 diabetes in treatment-naive elderly patients: benefits and risks of vildagliptin monotherapy.

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1
Vermont College of Medicine, Burlington, USA.

Abstract

OBJECTIVE:

The purpose of this study was to evaluate the efficacy and safety of vildagliptin in elderly patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS:

Efficacy data from five double-blind, randomized, placebo- or active-controlled trials of >or=24 weeks' duration were pooled. Effects of 24-week vildagliptin monotherapy (100 mg daily) were compared in younger (<65 years, n = 1,231) and older (>or=65 years, n = 238) patients. Safety data from eight controlled clinical trials of >or=12-weeks' duration were pooled; adverse event profiles in younger (n = 1,890) and older (n = 374) patients were compared.

RESULTS:

Mean baseline A1C and fasting plasma glucose (FPG) were significantly lower in older (70 years: 8.3 +/- 0.1% and 9.6 +/- 0.1 mmol/l, respectively) than in younger (50 years: 8.7 +/- 0.0% and 10.5 +/- 0.1 mmol/l, respectively) patients. Despite this, the adjusted mean change from baseline (AMDelta) in A1C was -1.2 +/- 0.1% in older and -1.0 +/- 0.0% in younger vildagliptin-treated patients (P = 0.092), and the AMDelta in FPG was significantly larger in older (-1.5 +/- 0.2 mmol/l) than in younger (-1.1 +/- 0.1 mmol/l, P = 0.035) patients. Body weight was significantly lower at baseline in older (83.4 +/- 1.0 kg) than in younger (92.0 +/- 0.6 kg) patients. Weight decreased significantly in the older subgroup (AMDelta -0.9 +/- 0.3 kg, P = 0.007), whereas smaller, nonsignificant decreases occurred in younger patients (AMDelta -0.2 +/- 0.1 kg). Adverse event rates were slightly higher in older than in younger subgroups but were lower among older, vildagliptin-treated subjects (63.6%) than in the pooled active comparator group (68.1%). Vildagliptin treatment did not increase adverse events among older patients with mild renal impairment (62.0%). Hypoglycemia was rare (0.8%) in the elderly patients, and no severe events occurred.

CONCLUSIONS:

Vildagliptin monotherapy was effective and well tolerated in treatment-naive elderly patients.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00099866 NCT00099905 NCT00099918 NCT00101673 NCT00101803 NCT00120536.

PMID:
17878242
DOI:
10.2337/dc07-1188
[Indexed for MEDLINE]
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