Evaluating alogliptin in elderly patients with type 2 diabetes

This study evaluated the effects of alogliptin (Nesina) in elderly patients with type 2 diabetes (T2D). The authors concluded that alogliptin significantly lowered blood glucose levels for these patients, with minimal side effects.

As T2D progresses, more intense treatment may be required. Many patients with T2D eventually need second-line anti-diabetic drugs for better blood glucose control. T2D also leads to long-term health complications, such as kidney disease. Kidney disease that is caused by diabetes is called diabetic nephropathy. This condition affects normal kidney function and can lead to kidney failure.

Alogliptin is a DPP-4 inhibitor. This treatment increases the production of a hormone called incretin, which is made by the body during meals. Incretin raises insulin levels when blood glucose levels are high. This helps reduce blood glucose levels. Previous studies showed that alogliptin improves blood glucose control without increasing body weight. However, the effects of alogliptin in elderly patients with T2D remain under investigation.

This study had 290 patients with T2D. Patients were divided into three groups based on age. 110 patients were under age 65, 87 patients were between ages 65 – 74, and 93 patients were age 75 or older. Data were collected every 3 months. Patients were followed-up for a total of 1 year.

Kidney blood filtration is a measurement of kidney function that is increased in kidney disease. In patients younger than 65, filtration significantly decreased from 89.0 mL/min to 80.9 mL/min at 12 months. In patients aged 65 – 74, filtration decreased from 76.7 mL/min to 75 mL/min at 12 months. In patients aged 75 or older, filtration decreased from 71.9 mL/min to 68.3 mL/min. Patients in this group showed a significant decrease of 2.9 mL/min after 3 months of treatment.

HbA1c (average blood glucose levels over the past 3 months) significantly decreased in all age groups. After 12 months of treatment, patients younger than 65 showed the greatest decrease (0.74%), followed by the 65 – 74 age group (0.47% decrease). In patients aged 75 or older, HbA1c dropped by 0.42%.

Patients younger than 65 who did not start anti-diabetes medication such as metformin (Glucophage) showed the most improvement in HbA1c levels. In these patients, HbA1c dropped from 7.46 to 6.78 after 12 months of treatment.

There were no significant changes in blood pressure, body weight, or body mass index (BMI; a measurement of weight in relation to height) between any of the groups. Low blood glucose levels (hypoglycemia) occurred in 2 patients, and 3 patients reported constipation.

The authors concluded that alogliptin significantly lowers HbA1c levels in elderly patients with T2D, with minimal side effects. The authors suggest that alogliptin treatment did not have significant side effects on the kidneys.

This study looked back in time to analyze data, which may bias the results. Also, this study had Japanese patients only, so these results may not apply to all patients. More studies are needed to confirm these results.