Saxagliptin has a low risk of hypoglycemia in older type 2 diabetes patients

This study compared the safety and efficacy of saxagliptin (Onglyza) plus metformin (Glucophage) to that of glimepiride (Amaryl) plus metformin in elderly type 2 diabetes patients.

Elderly type 2 diabetes patients have a higher risk of hypoglycemia (dangerously low blood glucose [sugar]) than younger patients. Therefore, it is important to choose glucose-lowering medications that minimize this risk. Saxagliptin is a glucose-lowering medication that increases the amount of insulin (the hormone needed to break down sugar taken in from food) produced by the body.

In younger adults, saxagliptin plus metformin is as effective as glimepiride (a drug that also increases insulin production) plus metformin. In older adults (age 65 and above), saxagliptin had a low risk of hypoglycemia compared to a placebo (substance with no effect on the body used for comparison). It is not clear whether saxagliptin plus metformin is more effective than glimepiride plus metformin in older adults.

The current study compared the safety and efficacy of saxagliptin and glimepiride in type 2 diabetics over the age of 65. 574 patients received either saxagliptin plus metformin or glimepiride plus metformin for 52 weeks. HbA1c (average blood glucose over 3 months), episodes of hypoglycemia, and adverse (negative) effects were measured.

Overall, a similar number of patients achieved an HbA1c less than 7.0% using saxagliptin (37.9%) and glimepiride (38.2%). A higher number of patients younger than 75 years achieved an HbA1c less than 7.0% with saxagliptin (39.2%) than glimepiride (33.3%). For patients older than 75 years, fewer patients achieved an HbA1c less than 7.0% with saxagliptin (35.9%) than glimepiride (45.5%).

Only 1.1% of patients receiving saxagliptin experienced severe hypoglycemia, compared to 15.3% of those receiving glimepiride. Of patients receiving glimepiride, more patients under 75 year experienced hypoglycemia (18.5%) than did patients over 75 (10.5%), and it occurred more often in patients who achieved HbA1c lower than 7.0%.

The most common adverse events experienced by the saxagliptin group included colds (6.4%), joint pain (4.7%), and diarrhea (4.2%). The most common adverse events experienced by the glimepiride group included colds (9.7%), diarrhea (5.3%), and urinary tract infection (5.3%). 

This study concluded that saxagliptin plus metformin was an effective and safe treatment, with a low risk of hypoglycemia, in older type 2 diabetes patients.

This study was funded by AstraZeneca and Bristol-Myers Squibb, the manufacturers of saxagliptin.