Vildagliptin provides similar glycated hemoglobin (HbA1c) reductions to metformin but with superior gastrointestinal tolerability in drug-naïve elderly patients with Type 2 diabetes, research shows.

Elderly people with diabetes are a challenging population to treat because of an increased risk for renal impairment, a high number of comorbidities and concomitant drug use, and a high prevalence of cardiovascular risk factors.

In the first study with vildagliptin to be conducted exclusively in Type 2 diabetes patients aged at least 65 years, Anja Schweizer (Novartis Pharma AG, Basel, Switzerland) and colleagues compared its efficacy and tolerability with that of metformin.

The 24-week study included 335 patients with an HbA1c of 7??”9% who had not received oral glucose-lowering agents for more than 3 consecutive months at any time in the past and no agents for at least 12 weeks prior to screening.

Patients were randomly assigned to receive vildagliptin 100 mg daily (given as a once-daily dose) or metformin titrated to a maximum of 1500 mg daily (given as 1000 mg in the morning and 500 mg in the evening).

The results, reported in the journal Diabetes, Obesity and Metabolism, show that patients receiving vildagliptin achieved similar HbA1c reductions to those taking metformin, at 0.64% and 0.75%, respectively, from baseline, and establish non-inferiority of vildagliptin to metformin.

As expected, the decrease in HbA1c with either agent was greater in patients with a baseline HbA1c greater than 8%, with mean HbA1c reductions from baseline of 0.93% with vildagliptin) and 1.02% with metformin.

Body weight decreased with both agents, although to a greater degree with metformin (0.45 kg versus 1.25 kg, respectively).

One or more adverse events were reported by 44.3% of patients receiving vildagliptin and 50.3% of patients receiving metformin. A low incidence of hypoglycemia was observed in both treatment groups.

In patients receiving vildagliptin, the most frequent adverse events were nasopharyngitis and dizziness, whereas gastrointestinal events were more frequently reported with metformin.

“We conclude that vildagliptin is effective and well tolerated in drug-naïve elderly patients with Type 2 diabetes in whom it could represent a valuable treatment option,” write the authors.

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