Background and Aims: For many patients with type 2 diabetes (T2DM) classic oral anti-diabetic treatment is not effective and patients don’t meet the currently recommended therapeutic goals. The aim of our study was to evaluate the efficacy of dipeptydil peptidase 4 (DPP-4) inhibitors as add-on therapy to oral antidiabetics in reducing HbA1c in elderly patients with poorly controlled T2DM. Material and methods: The study included 75 elderly patients with poorly controlled T2DM, treated with known oral antihyperglycemic agents. DPP-4 inhibitors were added to current oral treatment and patients were followed for 12 months, evaluating clinical and biological parameters at baseline and after 3 months, 6 months and 12 months of therapy. Results: After the first 3 months of treatment with DPP-4 inhibitors, fasting glucose (mg/dl) decreased from 148.27 ± 44.68 to 128.94 ± 22.71, and HbA1c (%) from 7.40 ± 1.39 to 6.93 ± 0.78. Values of these two parameters continued to decline until month 12 of follow-up, but to a lesser extent, up to mean fasting glucose (mg/dl) of 127.58 ± 20.91 and HbA1c (%) of 6.72 ± 0.52. Conclusion: Glycemic profile was significantly improved after 12 months of DPP-4 treatment, with a significant decrease of HbA1c.
1. International Diabetes Federation (IDF) Diabetes atlas. http://www.diabetesatlas.org, 2009.
2. Zeitler P. Update on nonautoimmune diabetes in children. J Clin Endocrinol Metab 94: 2215-2220, 2009.
3. Gaede P, Vedel P, Larsen N, Jensen GV,Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348: 383-393, 2003.
4. Holman RR, Paul SK, Bethel MA, MatthewsDR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359: 1577-1589, 2008.
5. German Diabetes Association, Matthaei S,Bierwirth R et al. Medical antihyperglycemic therapy of type 2 diabetes mellitus: update of the evidencebased guideline of the German Diabetes Association. Exp Clin Endocrinol Diabetes 117: 522-557, 2009.
6. National Institute for Health and Clinical Excellence http://www.guidance.nice.org.uk/ CG87, 2009.
7. Whitmer RA, Karter AJ, Yaffe K,Quesenberry CP Jr, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 301: 1565-1572, 2009.
8. Vilsboll T, Rosenstock J, Yki-Jarvinen H etal. Sitagliptin, a selective DPP-4 inhibitor, improves glycemic control when added to insulin, with or without metformin, in patients with type 2. Diabetes 58[Suppl 1]: 588, 2009.
9. Fonseca V, Baron M, Shao Q, Dejager S. Sustained efficacy and reduced hypoglycemia during one year of treatment with vildagliptin added to insulin in patients with type 2 diabetes mellitus. Horm MetabRes 40: 427-430, 2008.
10. Scheen AJ, Radermecker RP. Addition of incretin therapy to metformin in type 2 diabetes. Lancet 375: 1410-1412, 2010.
11. Arechavaleta R, Seck T, Chen Y et al. Efficacy and safety of treatment with sitagliptin or glimepiride in patients with type 2 diabetes inadequately controlled on metformin monotherapy: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab 13: 160-168, 2011.
12. Seck T, Nauck M, Sheng D et al. Safety and efficacy of treatment with sitagliptin or glipizide in patients with type 2 diabetes inadequately controlled on metformin: a 2-year study. Int J Clin Pract 64: 562-576, 2010.
13. Goke B, Gallwitz B, Eriksson J, Hellqvist A,Gause-Nilsson I; D1680C00001 Investigators. Saxagliptin is non-inferior to glipizide in patients with type 2 diabetes mellitus inadequately controlled on metformin alone: a 52-week randomised controlled trial. Int J Clin Pract 64: 1619-1631, 2010.
14. Filozof C, Gautier JF. A comparison of efficacy and safety of vildagliptin and gliclazide in combination with metformin in patients with type 2 diabetes inadequately controlled with metformin alone: a 52-week, randomized study. Diabet Med 27: 318-326, 2010.
15. Blonde L, Dagogo-Jack S, Banerji MA et al. Comparison of vildagliptin and thiazolidinedione as add-on therapy in patients inadequately controlled with metformin: results of the GALIANT trial - a primary care, type 2 diabetes study. Diabetes Obes Metab 11: 978-986, 2009.
16. Bergenstal RM, Wysham C, Macconell L etal. Efficacy and safety of exenatide once weekly versus sitagliptin or pioglitazone as an adjunct to metformin for treatment of type 2 diabetes (DURATION-2): a randomised trial. Lancet 376: 431-439, 2010.
17. Pratley RE, Nauck M, Bailey T et al. Liraglutide versus sitagliptin for patients with type 2 diabetes who did not have adequate glycaemic control with metformin: a 26-week, randomised, parallel-group, open-label trial. Lancet 375: 1447-1456, 2010.
18. Pratley R, Nauck M, Bailey T et al. One year of liraglutide treatment offers sustained and more effective glycaemic control and weight reduction compared with sitagliptin, both in combination with metformin, in patients with type 2 diabetes: a randomised, parallel-group, open-label trial. Int J ClinPract 65: 397-407, 2011.
19. Matikainen N, Mänttäri S, Schweizer A etal. Vildagliptin therapy reduces postprandial intestinal triglyceride-rich lipoprotein particles in patients with type 2 diabetes. Diabetologia 49: 2049-2057, 2006.
20. Fonseca V, Schweizer A, Albrecht D, BaronMA, Chang I, Dejager S. Addition of vildagliptin to insulin improves glycaemic control in type 2 diabetes. Diabetologia 50: 1148-1155, 2007.
21. Vilsboll T, Rosenstock J, Yki-Jarvinen H etal. Efficacy and safety of sitagliptin when added to insulin therapy in patients with type 2 diabetes. Diabetes Obes Metab 12: 167-177, 2010.
22. Barnett AH, Charbonnel B, Li J, DonovanM, Fleming D. Saxagliptin add-on therapy to insulin with or without metformin for type 2 diabetes mellitus: 52-week safety and efficacy. Diabetologia 54[Suppl. 1]: S108-S109, 2011.