Linagliptin for patients aged 70 years or older with type 2 diabetes inadequately controlled with common antidiabetes treatments: a randomised, double-blind, placebo-controlled trial

Barnett, Anthony; Huisman, Holger; Jones, Russell; Eynatten, Maximilian von; Patel, Sanjay; Woerle, Hans-Juergen

doi:10.1016/s0140-6736(13)61500-7

Cited by 163 publications

(154 citation statements)

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“…Due to their favorable safety profile, especially in terms of reduced hypoglycemia, DPP-4 inhibitors are pro bably the only oral glucose-lowering agents for which some evidence from dedicated randomized clinical trials in patients aged ≥65 years and/or with moderate to severe renal impairment has been published over the last few years. 3,19,[32][33][34][35][36][37][38][39][40] One of these studies, a randomized, placebocontrolled trial in 133 patients with type 2 diabetes (HbA1c 7%-10%) and severe renal impairment (eGFR <30 mL/min per 1.73 m 2 ) showed that adding linagliptin (5 mg/day) to existing background therapy resulted in a significantly greater reduction of HbA1c at 12 weeks 36 which was maintained at 1 year (P<0.0001 vs baseline). In linagliptin-treated patients the incidence of adverse events and severe hypoglycemia was similar to the placebo group.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] According to an analysis performed by the Italian Association of Clinical Diabetologists (AMD), 60% of the 414,814 patients with type 2 diabetes who referred to national diabetes centers in 2009 were older than 65 years. 4 Treatment of elderly patients with diabetes is challenging because of the high prevalence of comorbidities, diabetes complications, polypharmacy and frailty.…”

Section: Introductionmentioning

confidence: 99%

“…22,23 In phase 3 studies in patients with type 2 diabetes aged up to 80 years, linagliptin showed clinically relevant glucose-lowering effects, with a low frequency of hypoglycemia. [24][25][26][27][28] In a recent 24-week, randomized, placebo-controlled trial in patients aged ≥70 years, linagliptin (5 mg once daily) in addition to the existing glucose-lowering treatment was associated with a clinically meaningful improvement in glycemic control; 3 notably, the efficacy of linagliptin was not influenced by age, renal impairment, or diabetes duration.…”

Section: Introductionmentioning

confidence: 99%

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Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

et al. 2016

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The treatment of diabetes in frail elderly patients with decreased renal function is challenging and insufficiently supported by evidence. Due to their good tolerability and low hypoglycemic risk, oral dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as a reasonable option for glycemic control in the elderly. The aim was to evaluate the efficacy and safety of linagliptin, a long acting, oral DPP-4 inhibitor with a predominantly nonrenal elimination route, in elderly patients with severe chronic kidney disease (CKD). This was a retrospective, observational study in outpatients with type 2 diabetes and advanced-stage CKD (estimated glomerular filtration rate <30 mL/min per 1.73 m 2 ) referring to a diabetes clinic in Italy. Patients were switched from basal insulin to oral linagliptin 5 mg once daily and observed for 14 months. Assessed variables included glycemic control (HbA1c target, 7.5%-8.0%), adherence to treatment (Morisky questionnaire) and patient satisfaction (diabetes treatment satisfaction questionnaire). Adverse events, including hypoglycemic episodes, were also recorded. Thirty patients [mean (±standard deviation) age 70.2 (±8.2) years, HbA1c 7.6% (±0.3), fasting blood glucose 173.9 (±23.5) mg/dL] with type-2 diabetes and advanced CKD were included. The switch to linagliptin did not affect significantly glycemic control, was well tolerated and associated with a reduction in hypoglycemic episodes. Adherence to treatment was better with linagliptin than basal insulin and patient satisfaction significantly improved after switching. Linagliptin appears as a valid option for glycemic control in elderly diabetes patients with severe CKD in treatment with low-dose insulin. However adequately designed longterm studies are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

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“…There were more hypoglycaemic episodes and slight weight gain in the glargine group where as there was slight weight loss in the Sitagliptin group. A recent study compared the effect of sitagliptin or glibenclamide in addition to metformin and pioglitazone on glycaemic control and beta cell function [102] . Body weight reached was lower with sitagliptin.…”

Section: Sitagliptinmentioning

confidence: 99%

“…Although linagliptin was effective the patients had a mean HbA1c of 9.0% and the level of HbA1c only dropped to 8.3% still unacceptably high for many patients. DPP-4 inhibitors unfortunately work less well the lower the starting HbA1c [102] . A study of linagliptin in patients aged over 70 years found that HbA1c was lowered by 0.64% from 7.8% to 7.2% with a safety profile similar to placebo.…”

Section: Linagliptinmentioning

confidence: 99%

Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors

Tomkin¹

2014

WJD

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Core tip: Treatment of diabetes is difficult. Initial success in achieving treatment goals is followed by deterioration and the necessity for additional treatments. Exciting new drugs with new modes of action, have stimulated diabetologists to strive for improved control in the knowledge that complications will be reduced or prevented. Obese patients, who loose weight on glucagon-like peptide-1 agonists are usually delighted with these drugs but for those who fail to loose weight changing to oral dipeptidyl peptidase-4 inhibitors would seem a good choice. sodium-glucose transporter-2 inhibitors have the added benefit of being effective even if blood sugar is near to target but uro-genital infection is a concern.Tomkin GH. Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors. World J Diabetes 2014; 5(5): 636-650 Available from: URL: http://www.wjgnet.com/1948-9358/full/ v5/i5/636.htm DOI: http://dx.doi.org/10. 4239/wjd.v5.i5.636 INTRODUCTIONReaders interested in diabetes must be sick and tired reading that diabetes is a global problem of immense size and getting worse by the day with predictions that we will all have the disease one day! I exaggerate of course but it is sad to realise that although we know so much more about the condition we have made little progress in reducing or conquering the disease. A recent history of diabetes in the past 200 years by Polonsky [1] gives an excellent review of the history of discovery of so many mechanisms that are faulty in diabetes and the number of Nobel prize winners who have contributed to such wonderful success, yet more and more people are being diagnosed with the condition/disease and the consequences are immense in terms of suffering and financial cost. One should not forget that before the discovery of insulin 90 years ago AbstractIn recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes. Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality. Drugs which inhibit glucose re-absorption in the kidney, sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.© 2014 Baishideng Publishing Group Inc. All rights reserved. 636October 15, 2014|Volume 5|Issue 5| WJD|www.wjgnet.com diabetes was a rapidly fatal disease and there was little interest in what we now term type 2 diabetes. Type 2 diabetes now makes up 90% of all diabetes. Insulin resist...

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Effect of Patients’ Risks and Preferences on Health Gains With Plasma Glucose Level Lowering in Type 2 Diabetes Mellitus

et al. 2014

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Linagliptin for patients aged 70 years or older with type 2 diabetes inadequately controlled with common antidiabetes treatments: a randomised, double-blind, placebo-controlled trial

Cited by 163 publications

References 32 publications

Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors

Effect of Patients’ Risks and Preferences on Health Gains With Plasma Glucose Level Lowering in Type 2 Diabetes Mellitus

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