Can linagliptin improve glucose control in older people with type 2 diabetes?

This study examined if linagliptin (Tradjenta) was safer and more effective in older patients with Type 2 diabetes compared to a placebo. This study concluded that linagliptin helped improve glucose control for these patients without causing additional side effects.

About 90% of diabetes cases are of Type 2 diabetes (T2D). The goal of treatment for T2D is to lower blood glucose levels. One such treatment is insulin. However, increasing doses of insulin therapy can lead to hypoglycemia (low blood sugar; HG). About 20% to 40% of older patients with T2D develop HG.

HG can cause health complications such as irregular heartbeat and altered cognitive function. These, in turn, can also lead to increased falls or injury. Because older patients with T2D often have other health conditions, hypoglycemia can be particularly serious. ?Linagliptin is a drug that can help reduce blood sugar levels and may also prevent hypoglycemia. Whether linagliptin is safe and effective for older patients with T2D is unclear.

This study recruited 302 older patients receiving insulin therapy for T2D. Patients were divided into two groups. Half of the patients received linagliptin, and the other half received a placebo (a substance with no active effect). HbA1c (average blood glucose over 3 months) and fasting sugar levels were measured at the beginning of the study and during follow-up. Patients were followed-up for an average of 24 weeks.

Overall, significantly more patients who received linagliptin had HbA1c levels drop by 0.5% or more compared to placebo (69.1% vs. 37.4%). Linagliptin also significantly reduced fasting blood sugar levels compared to placebo (11.3 mg/dL vs. 0.2 mg/dL).

At follow-up, linagliptin treatment significantly reduced HbA1c levels by 0.63% compared to placebo. Linagliptin was significantly associated with a 5.02-fold higher chance of lowering HbA1c levels below 8%. The odds of reducing HbA1c levels below 7% was 4.69-fold higher with linagliptin.

Overall, there was no significant difference in the number of patients who experienced side effects in the linagliptin group versus placebo (67.5% vs. 64.9%). Most side effects were mild. Slightly more patients in the linagliptin group experienced HG compared to placebo (15.9% vs. 15.2%). However, serious side effects were somewhat more common in the placebo group compared to linagliptin (13.9% vs. 12.6%).

The authors concluded that linagliptin helped improve glucose control in older patients with T2D taking insulin without increasing the risk of hypoglycemia.

This study received funding from the manufacturer of linagliptin, Boehringer Ingelheim. 33% of the patients in this study were Japanese, so these results may not be applicable for all patients. Also, this study had a very short follow-up time (24 weeks). More studies are needed to confirm these results.

Talk to your doctor about the potential benefits of linagliptin.