Aims/introduction: Despite type 2 diabetes mellitus being up to five times more prevalent in patients aged ≥65 years compared with patients <65 years of age, this population is surprisingly less well studied. Dipeptidyl peptidase (DPP)-4 inhibitor treatment is an option for this older patient group, but clinical practice data for this drug class are sparse in this population. The study examined the efficacy and tolerability of DPP-4 inhibitors in older patients with type 2 diabetes whilst focusing on particular pertinent aspects relevant to care of older persons. Materials and methods: The medical records of 431 randomly selected patients (median age 74 years) were reviewed and two cohorts (DPP-4-inhibitor-treated and non-DPP-4-inhibitors-treated) were compared. Results: Both groups had a similar duration of diabetes (8 years) and comparable glycated haemoglobin A1C concentrations (7.4% and 7.2%). Hypoglycaemia was less common in the DPP-4 inhibitor group (3%) compared with the medically treated non-DPP-4 inhibitor group (8%), p<0.02. Despite significantly more patients in the non-DPP-4 inhibitor group living in cared accommodation (9% vs. 2%) this group received significantly more insulin (30% vs. 7%). Conclusion: Clinicians need to consider the specific clinical issues relevant to older diabetic patients when taking complex treatment decisions.

Summary Background Little data exist on the referral patterns and effectiveness of lipid clinics. Methods An audit was conducted in four clinics of 100 consecutive referrals each. Data were recorded on referral criteria, cardiovascular disease (CVD) risk factors, drug history, investigations, diagnoses, therapies, results and referrals. Results Patients were aged 56 ± 14 years, 47% were male and 87% were primary prevention. Risk factors included smoking (16%), type 2 diabetes (13%) and hypertension (13%). Referrals were made for hypercholesterolaemia (68%), diagnosis of FH (31%), statin intolerance (23%) and hypertriglyceridaemia (23%). Initial total cholesterol (TC) was 7.65 ± 2.64 mmol/L, triglycerides (TG) 2.17 (0.41‐76.9 mmol/L) mmol/L, HDL‐C 1.53 ± 0.71 mmol/L, LDL‐C 4.57 ± 1.66 mmol/L with non‐HDL‐C 5.90 ± 2.09 mmol/L. Criteria for FH were met in 21% with genetic testing in 13% and lipid cascade testing in 30% of index cases. Triglycerides >20 mmol/L were present in 4%. The diagnosis was changed in 21%: hypercholesterolaemia (7%), mixed hyperlipidaemia (7%) and hypertriglyceridaemia (7%). Hepatic steatosis was identified in 14.5%. Lipoprotein(a) levels >125 nmol/L occurred in 41% in one clinic. Therapy changes included altered statins (40%), addition of a fibrate (11%) or ezetimibe (8%). These reduced TC by 1.92 mmol/L (19%; P = 0.0001), LDL‐C 1.07 mmol/L (15%; P = 0.02), non‐HDL‐C 1.50 mmol/L (16%; P < 0.001), and TG 2.3 (−4 to 38) mmol/L (16%; P < 0.001) with 11% extra achieving TG <5 mmol/L while HDL‐C increased by 7% (P = 0.37). Conclusions Lipid clinics have diverse functions including diagnosis of FH, managing severe hypercholesterolaemia, mixed hyperlipidaemia and statin intolerance. Effectiveness criteria of average reductions of 1.5 mmol/L in TC or non‐HDL‐C, 1 mmol/L in LDL‐C and 2 mmol/L in TG would be reasonable for newly referred patients.

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