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Dipeptidyl peptidase 4 (DPP-4) inhibitors control blood glucose by increasing the active levels of incretin hormone in the body. The inhibitors do not have any appreciable adverse effect such as increase in body weight or hypoglycemia. Clinical evidence suggests that the DPP- 4 inhibitors are particularly suitable for elderly patients because of their excellent profiles of the tolerability in these patients. The purpose of this study was to evaluate the efficacy and safety of DPP-4 inhibitors in elderly patients with type 2 diabetes mellitus. Patients, aged not less than 65 years, receiving Vildagliptin (Galvus?) or Sitagliptin (Januvia?) in Seoul National University Bundang Hospital, were included in this study and the efficacy/safety evaluated by a retrospective review of their charts using the electronic medical records (EMRs). In this study, total of 60 patients were classified, based on their prescription status, into two groups: ‘additional’(i.e., DPP-4 inibitor + other antidiabetic agent) group (n=28) or ‘altered’(i.e., one of antidiabetic agents changed to DPP-4 inhibitor) group (n=32). Hemoglobin A1c (HbA1c) and fasting blood sugar (FBS) level for each group were compared before and after the initiation of DPP-4 inhibitors therapy. In some patient who had adequate records, their history of hypoglycemia, variability in body weight, and another significant adverse drug effects were also reviewed to assess safety. Three to five months of the therapy, patients in‘ additional’group associated with a greater HbA1c reduction [i.e., 8.1±0.9% → 7.1±0.6%, p<0.00001] than those in ‘altered’group [7.3±0.9% → 7.1±0.8%, p=0.209], indicating that the reduction is comparable in both groups and a statistically significant reduction was noted in ‘additional’group only. In addition, FBS was found to be reduced in‘ additional’group [i.e., 146.8±46.4 mg/dL → 127.9±27.0 mg/dL, p=0.068], but not in‘ altered’group [i.e., 140.8±46.3 mg/dL → 140.3±38.1 mg/dL, p=0.963]. Adverse event profiles were not consolidated for all patients because some patients had incomplete records. The number of patients experiencing hypoglycemia was decreased (7 pts → 3 pts, N = 15 pts) after the initiation of DPP-4 inhibitors and no incidence of new hypoglycemia was found. In addition, there was no significant decrease in body weight with the DPP-4 inhibitors (mean body weight: 61.3±8.1 kg → 61.2±8.1 kg, p=0.955). Therefore, these observations indicate that DPP-4 inhibitors offer advantages such as the ability to achieve sustainable reductions in HbA1c with a minimum risk of hypoglycemia and no appreciable gain in body weight and that DPP-4 inhibitor therapy may be more suitable for elderly patients with type 2 diabetes.
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