Skip to main content
SpringerLink
Log in

New Approaches to Treating Type 2 Diabetes Mellitus in the Elderly

Role of Incretin Therapies

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The increasing proportion of elderly persons in the global population, and the implications of this trend in terms of increasing rates of chronic diseases such as type 2 diabetes mellitus, continue to be a cause for concern for clinicians and healthcare policy makers. The diagnosis and treatment of type 2 diabetes in the elderly is challenging, as age-related changes alter the clinical presentation of diabetic symptoms. Once type 2 diabetes is diagnosed, the principles of its management are similar to those in younger patients, but with special considerations linked to the increased prevalence of co-morbidities and relative inability to tolerate the adverse effects of medication and hypoglycaemia. In addition, there are many underappreciated factors complicating diabetes care in the elderly, including cognitive disorders, physical disability and geriatric syndromes, such as frailty, urinary incontinence and pain. Available oral antihyperglycaemic drugs include insulin secretagogues (meglitinides and sulfonylureas), biguanides (metformin), α-glucosidase inhibitors and thiazolidinediones. Unfortunately, as type 2 diabetes progresses in older persons, polypharmacy intensification is required to achieve adequate glycaemic control with the attendant increased risk of adverse effects as a result of age-related changes in drug metabolism. The recent introduction of the incretins, a group of intestinal peptides that enhance insulin secretion after ingestion of food, as novel oral antihyperglycaemic treatments may prove significant in older persons. The two main categories of incretin therapy currently available are: glucagon-like peptide-1 (GLP-1) analogues and inhibitors of GLP-1 degrading enzyme dipeptidyl peptidase-4 (DPP-4). The present review discusses the effect of aging on metabolic control in elderly patients with type 2 diabetes, the current treatments used to treat this population and some of the more recent advances in the field of geriatric type 2 diabetes. In particular, we highlight the efficacy and safety of GLP-1 and DPP-4 inhibitors, administered as monotherapy or in combination with other oral antihyperglycaemic agents, especially when the relevant clinical trials included older persons. There is strong evidence that use of incretin therapy, in particular, the DPP-4 inhibitors, could offer significant advantages in older persons. Clinical evidence suggests that the DPP-4 inhibitors vildagliptin and sitagliptin are particularly suitable for frail and debilitated elderly patients because of their excellent tolerability profiles. Importantly, these agents lack the gastrointestinal effects seen with metformin and α-glucosidase inhibitors taken alone, and have a low risk of the hypoglycaemic events commonly seen with agents that directly lower blood glucose levels.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Table I
Table II

Similar content being viewed by others

References

  1. Rosenstock J. Management of type 2 diabetes mellitus in the elderly: special considerations. Drugs Aging 2001; 18(1): 31–44

    Article  PubMed  CAS  Google Scholar 

  2. US Census Bureau. American FactFinder: United States S0101. Age and sex: data set: 2006 American Community Survey [online]. Available from URL: http://factfinder.census.gov/servlet/STTable?._bm=y&geo_id=01000US&qr_name=ACS_2006_EST_G00_S0101&ds_name=ACS_2006_EST_G00_&redoLog=false. [Accessed 2007 Oct 31]

  3. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: the third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care 1998; 21: 518–24

    Article  PubMed  CAS  Google Scholar 

  4. Gossain VV, Carella MJ, Rovner DR. Management of diabetes in the elderly: a clinical perspective. J Assoc Acad Minority Phys 1994; 5: 22–31

    CAS  Google Scholar 

  5. American Diabetes Association. Economic costs of diabetes in the U.S. in 2002. Diabetes Care 2003; 26: 917–32

    Article  Google Scholar 

  6. Meneilly GS, Tessier D. Diabetes in elderly adults. J Gerontol A Biol Sci Med Sci 2001; 56(1): M5–13

    Article  PubMed  CAS  Google Scholar 

  7. Meneilly GS. Diabetes. In: Evans JG, Williams TF, Beattie BL, et al., editors. Oxford textbook of geriatric medicine. 2nd ed. New York: Oxford University Press, 2000: 210–7

    Google Scholar 

  8. Damsgaard EM, Froland A, Jorgensen OD, et al. Microalbumin-uria as a predictor of increased mortality in elderly people. BMJ 1990; 300: 297–8

    Article  PubMed  CAS  Google Scholar 

  9. Kempen JH, O’Colmain BJ, Leske MC, et al. The prevalence of diabetic retinopathy among adults in the United States. Arch Ophthalmol 2004; 122(4): 522–63

    Google Scholar 

  10. Lee PP, Feldman ZW, Ostermann J, et al. Longitudinal prevalence of major eye diseases. Arch Ophthalmol 2003; 121(9): 1303–10

    Article  PubMed  Google Scholar 

  11. Cohen DL, Neil HAW, Thorogood M, et al. A population based study of the incidence of complications associated with type 2 diabetes in the elderly. Diabet Med 1991; 8: 928–33

    Article  PubMed  CAS  Google Scholar 

  12. Dornan TL, Peck GM, Dow JDC, et al. A community survey of diabetes in the elderly. Diabet Med 1992; 9: 860–5

    Article  PubMed  CAS  Google Scholar 

  13. Ingelsson E, Sundstrom J, Arnlov J, et al. Insulin resistance and risk of congestive heart failure. JAMA 2005; 294(3): 334–41

    Article  PubMed  CAS  Google Scholar 

  14. Gregg EW, Yaffe K, Cauley JA, et al. Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 2000 Jan 24; 160(2): 174–80

    Article  PubMed  CAS  Google Scholar 

  15. Haan MN, Shemanski L, Jagust WJ, et al. The role of APOE epsilon4 in modulating effects of other risk factors for cognitive decline in elderly persons. JAMA 1999; 282: 40–6

    Article  PubMed  CAS  Google Scholar 

  16. Knopman D, Boland LL, Mosley T, et al. Atherosclerosis Risk in Communities (ARIC) study investigators: cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 2001; 56: 42–8

    Article  PubMed  CAS  Google Scholar 

  17. Fontbonne A, Berr C, Ducimetiere P, et al. Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 2001; 24: 366–70

    Article  PubMed  CAS  Google Scholar 

  18. Ott A, Stolk RP, Hofman A, et al. Association of diabetes mellitus and dementia: the Rotterdam Study. Diabetologia 1996; 39: 1392–7

    Article  PubMed  CAS  Google Scholar 

  19. Luchsinger JA, Tang M, Stern Y, et al. Diabetes mellitus and risk of Alzheimer’s disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol 2001; 154: 635–41

    Article  PubMed  CAS  Google Scholar 

  20. Biessels GJ, van der Heide LP, Kamal A, et al. Ageing and diabetes: implications for brain function. Eur J Pharmacol 2002; 441(1–2): 1–14

    Article  PubMed  CAS  Google Scholar 

  21. Abbatecola AM, Rizzo MR, Barbieri M, et al. Postprandial plasma glucose excursions and cognitive functioning in aged type 2 diabetics. Neurology 2006; 67(2): 235–40

    Article  PubMed  CAS  Google Scholar 

  22. Feil D, Weinreb J, Sultzer D. Psychiatric disorders and psychotropic medication use in elderly persons with diabetes. Ann Long Term Care 2006; 14(7): 39–47

    Google Scholar 

  23. Maty SC, Fried LP, Volpato S, et al. Patterns of disability related to diabetes mellitus in older women. J Gerontol A Biol Sci Med Sci 2004; 59(2): 148–53

    Article  PubMed  Google Scholar 

  24. Miller DK, Lui LY, Perry 3rd HM, et al. Reported and measured physical functioning in older inner-city diabetic African Americans. J Gerontol A Biol Sci Med Sci 1999; 54(5): M230–6

    Article  PubMed  CAS  Google Scholar 

  25. Gregg EW, Mangione CM, Cauley JA, et al. Diabetes and incidence of functional disability in older women. Diabetes Care 2002; 25: 61–7

    Article  PubMed  Google Scholar 

  26. Schwartz AV, Sellmeyer DE, Ensrud KE, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001; 86: 32–8

    Article  PubMed  CAS  Google Scholar 

  27. Volpato S, Leveille SG, Blaum C, et al. Risk factors for falls in older disabled women with diabetes: the Women’s Health and Aging Study. J Gerontol A Biol Sci Med Sci 2005; 60(12): 1539–45

    Article  PubMed  Google Scholar 

  28. Gregg EW, Beckles GL, Williamson DF, et al. Diabetes and physical disability among U.S. adults. Diabetes Care 2000; 23: 1272–7

    Article  PubMed  CAS  Google Scholar 

  29. Brown JS, Vittinghoff E, Lin F, et al. Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: findings from the National Health and Nutrition Examination Survey (NHANES) 2001–2002. Diabetes Care 2006; 29(6): 1307–12

    Article  PubMed  Google Scholar 

  30. Fried LP, Tangen CM, Walston J, et al. Cardiovascular Health Study Collaborative Research Group: frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146–56

    Article  PubMed  CAS  Google Scholar 

  31. Rockwood K, Hogan DB, MacKnight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging 2000; 17(4): 295–302

    Article  PubMed  CAS  Google Scholar 

  32. Vanitallie TB. Frailty in the elderly: contributions of sarcopenia and visceral protein depletion. Metabolism 2003; 52 (10 Suppl. 2): 22–6

    Article  PubMed  Google Scholar 

  33. Cigolle CT, Langa KM, Kabeto MU, et al. Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med 2007; 147(3): 156–64

    PubMed  Google Scholar 

  34. Walston J, McBurnie MA, Newman A, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 2002; 162(20): 2333–41

    Article  PubMed  Google Scholar 

  35. Baumgartner RN, Wayne SJ, Waters DL, et al. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004; 12(12): 1995–2004

    Article  PubMed  Google Scholar 

  36. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 2002; 162(20): 2269–76

    Article  PubMed  Google Scholar 

  37. Shorr RI, Ray WA, Daugherty JR, et al. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med 1997; 157: 1681–6

    Article  PubMed  CAS  Google Scholar 

  38. Inzucchi SE, McGuire DK. New drugs for the treatment of diabetes: part II. Incretin-based therapy and beyond. Circulation 2008 Jan 29; 117(4): 574–84

    Article  PubMed  Google Scholar 

  39. Mathieu C, Bollaerts K. Antihyperglycaemic therapy in elderly patients with type 2 diabetes: potential role of incretin mimetics and DPP-4 inhibitors. Int J Clin Pract Suppl Aug 2007; (154): 29–37

    Google Scholar 

  40. Gallwitz B. Glucagon-like peptide-1-based therapies for the treatment of type 2 diabetes mellitus. Treat Endocrinol 2005; 4(6): 361–70

    Article  PubMed  CAS  Google Scholar 

  41. Orskov C, Wettergren A, Holst JJ. Biological effects and metabolic rates of glucagon-like peptide-17-36 amide on glucagonlike peptide-1 7–37 in healthy subjects are indistinguishable. Diabetes 1993; 42: 658–61

    Article  PubMed  CAS  Google Scholar 

  42. Drucker DJ, Nauck M. The incretin system: glucagon-like pep-tide 1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet 2006; 368: 1696–705

    Article  PubMed  CAS  Google Scholar 

  43. MacDonald PE, El-Kholy W, Riedel MJ, et al. The multiple actions of GLP-1 on the process of glucose-stimulated insulin secretion. Diabetes 2002; 51Suppl. 3: S434–42

    Article  PubMed  CAS  Google Scholar 

  44. List JF, Gabener JF. Glucagon-like peptide 1 agonists and the development and growth of pancreatic beta cells. Am J Physiol Endocrinol Metab 2004; 266: E875–81

    Article  Google Scholar 

  45. Brubaker PL, Drucker DJ. Minireview: glucagon-like peptides regulate cell proliferation and apoptosis in the pancreas, gut, and central nervous system. Endocrinology 2004; 145: 2653–9

    Article  PubMed  CAS  Google Scholar 

  46. Meier JJ, Hucking K, Holst JJ, et al. Reduced insulinotropic effect of gastric inhibitory polypeptide in first-degree relatives of patients with type 2 diabetes. Diabetes 2001; 50: 2497–504

    Article  PubMed  CAS  Google Scholar 

  47. Gutniak M, Orskov C, Holst JJ, et al. Antidiabetogenic effect of glucagon-like peptide-1 [7–36]amide in normal subjects and patients with diabetes mellitus. New Engl J Med 1992; 326: 1316–22

    Article  PubMed  CAS  Google Scholar 

  48. Nathan DM, Schreiber E, Fogel H, et al. Insulinotropic action of glucagon-like peptide I-[7–37] in diabetic and nondiabetic subjects. Diabetes Care 1992; 15: 270–6

    Article  PubMed  CAS  Google Scholar 

  49. Meneilly GS, Greig N, Tidesley H, et al. Effects of 3 months of continuous subcutaneous administration of glucagon-like peptide 1 in elderly patients with type 2 diabetes. Diabetes Care 2003; 26: 2835–41

    Article  PubMed  CAS  Google Scholar 

  50. Meneilly GS, Mcintosh CH, Pederson RA, et al. Effect of glucagon-like peptide 1 on non-insulin-mediated glucose uptake in the elderly patient with diabetes. Diabetes Care 2001; 24: 1951–6

    Article  PubMed  CAS  Google Scholar 

  51. Meneilly GS, Mcintosh CH, Pederson RA, et al. Glucagon-like peptide-1 [7–37] augments insulin release in elderly patients with diabetes. Diabetes Care 2001; 24: 964–5

    Article  PubMed  CAS  Google Scholar 

  52. Meneilly GS, Mcintosh CH, Pederson RA, et al. Glucagon-like peptide-1 [7–37] augments insulin-mediated glucose uptake in elderly patients with diabetes. J Gerontol A Biol Sci Med Sci 2001; 56: M681–5

    Article  PubMed  CAS  Google Scholar 

  53. Nauck MA, Heimesaat MM, Behle K, et al. Effects of glucagon-like peptide 1 on counterregulatory hormone responses, cognitive functions and insulin secretion during hyperinsulinemic, stepped hypoglycemic clamp experiments in healthy volunteers. J Clin Endocrinol Metab 2002; 87: 1239–46

    Article  PubMed  CAS  Google Scholar 

  54. Nikolaidis LA, Elahi D, Hentosz T, et al. Recombinant glucagon-like peptide-1 increases myocardial glucose uptake and improves left ventricular performance in conscious dogs with pacing-induced dilated cardiomyopathy. Circulation 2004; 110: 955–61

    Article  PubMed  CAS  Google Scholar 

  55. Nikolaidis LA, Doverspike A, Hentosz T, et al. Glucagon-like peptide-1 limits myocardial stunning following brief coronary occlusion and reperfusion in conscious canines. J Pharmacol Exp Ther 2005; 312(1): 303–8

    Article  PubMed  CAS  Google Scholar 

  56. Nystrom T, Gutniak MK, Zhang Q, et al. Effects of glucagon-like peptide-1 on endothelial function in type 2 diabetes patients with stable coronary artery disease. Am J Physiol Endocrinol Metab 2004; 287: E1209–15

    Article  PubMed  CAS  Google Scholar 

  57. During MJ, Lei C, Zuzga DS, et al. Glucagon-like peptide-1 receptor is involved in learning and neuroprotection. Nat Med 2003; 9(9): 1173–9

    Article  PubMed  CAS  Google Scholar 

  58. Kolterman OG, Kim DD, Shen L, et al. Pharmacokinetics, pharmacodynamics, and safety of exenatide in patients with type 2 diabetes mellitus. Am J Health Syst Pharm 2005; 62: 173–81

    PubMed  CAS  Google Scholar 

  59. Buse JB, Henry RR, Han J, et al. Effects of exenatide (exendin-4) on glycemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes. Diabetes Care 2004; 27(11): 2628–35

    Article  PubMed  CAS  Google Scholar 

  60. DeFronzo RA, Ratner RE, Han J, et al. Effects of exenatide (exendin-4) on glycemic control and weight over 30 weeks in patients with type 2 diabetes. Diabetes Care 2005; 28(5): 1092–100

    Article  PubMed  CAS  Google Scholar 

  61. Kendall DM, Riddle MC, Rosenstock J, et al. Effects of exenatide (exendin-4) on glycemic control over 30 weeks in patients with type 2 diabetes treated with metformin and a sulfonylurea. Diabetes Care 2005; 28(5): 1083–91

    Article  PubMed  CAS  Google Scholar 

  62. Cvetković RS, Plosker GL. Exenatide: a review of its use in patients with type 2 diabetes mellitus (as an adjunct to metformin and/or a sulfonylurea). Drugs 2007; 67(6): 935–54

    Article  PubMed  Google Scholar 

  63. Heine RJ, Van Gaal LF, Johns D, et al. Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: a randomized trial. Ann Intern Med 2005; 143: 559–69

    PubMed  CAS  Google Scholar 

  64. Nauck MA, Duran S, Kim D, et al. A comparison of twice-daily exenatide and biphasic insulin aspart in patients with type 2 diabetes who were suboptimally controlled with sulfonylurea and metformin: a non-inferiority study. Diabetologia 2007; 50: 259–67

    Article  PubMed  CAS  Google Scholar 

  65. Degn KB, Juhl CB, Sturis J, et al. One week’s treatment with the long-acting glucagon-like peptide 1 derivative liraglutide (NN2211) markedly improves 24-h glycemia and α- and α-cell function and release in patients with type 2 diabetes. Diabetes 2004; 53(5): 1187–94

    Article  PubMed  CAS  Google Scholar 

  66. Madsbad S, Schmitz O, Ranstam J, et al. Improved glycemic control with no weight increase in patients with type 2 diabetes after once-daily treatment with the long-acting glucagon-like peptide 1 analog liraglutide (NN2211): a 12-week, doubleblind, randomized, controlled trial. Diabetes Care 2004; 27(6): 1335–42

    Article  PubMed  CAS  Google Scholar 

  67. Visbøll T, Zdravkovic M, Le-Thi T, et al. Liraglutide significantly improves glycemic control and lowers body weight without risk of either major or minor hypoglycemic episodes in subjects with type 2 diabetes [abstract no. 115-OR]. Diabetes 2006; 55Suppl. 1: 27–8

    Google Scholar 

  68. Vilsbøll T. Liraglutide: a once-daily GLP-1 analogue for the treatment of type 2 diabetes mellitus. Expert Opin Investig Drugs 2007; 16: 231–7

    Article  PubMed  Google Scholar 

  69. Feinglos MN, Saad MF, Pi-Sunyer FX, et al. Effects of liraglutide (NN2211), a long-acting GLP-1 analogue, on glycemic control and bodyweight in subjects with type 2 diabetes. Diabet Med 2005; 22: 1016–23

    Article  PubMed  CAS  Google Scholar 

  70. Harder H, Nielsen L, Tu DT, et al. The effect of liraglutide, a long-acting glucagon-like peptide 1 derivative, on glycemic control, body composition, and 24-h energy expenditure in patients with type 2 diabetes. Diabetes Care 2004; 27: 1915–21

    Article  PubMed  CAS  Google Scholar 

  71. Unger RH. Alpha- and beta-cell interrelationships in health and disease. Metabolism 1974; 23: 581–93

    Article  PubMed  CAS  Google Scholar 

  72. Lyseng-Williamson KA. Sitagliptin. Drugs 2007; 67(4): 587–97

    Article  PubMed  CAS  Google Scholar 

  73. Hanefeld M, Herman G, Mickel C, et al. Effect of MK-0431, a dipeptidyl peptidase IV inhibitor, on glycemic control after 12 weeks in patients with type 2 diabetes [abstract no. 791]. Diabetologia 2005; 48Suppl. 1: A287

    Google Scholar 

  74. Scott R, Wu M, Sanchez M, et al. Efficacy and tolerability of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy over 12 weeks in patients with type 2 diabetes. Int J Clin Pract 2007; 61: 171–80

    Article  PubMed  CAS  Google Scholar 

  75. Nonaka K, Kakikawa T, Sato A, et al. Twelve-week efficacy and tolerability of sitagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4), in Japanese patients with type 2 diabetes [abstract no. 0038]. Diabetologia 2006; 49Suppl. 1: 25–6

    Google Scholar 

  76. Raz I, Hanefeld M, Xu L, et al. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy in patients with type 2 diabetes mellitus. Diabetologia 2006; 49: 2564–71

    Article  PubMed  CAS  Google Scholar 

  77. Aschner P, Kipnes MS, Lunceford JK, et al. Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy on glycemic control in patients with type 2 diabetes. Diabetes Care 2006; 29: 2632–7

    Article  PubMed  CAS  Google Scholar 

  78. Chan JC, Scott R, Arjona Ferreira JC, et al. Safety and efficacy of sitagliptin in patients with type 2 diabetes and chronic renal insufficiency. Diabetes Obes Metab 2008; 10(7): 545–55

    Article  PubMed  CAS  Google Scholar 

  79. Brazg R, Xu L, Dalla Man C, et al. Effect of adding sitagliptin, a dipeptidyl peptidase-4 inhibitor, to metformin on 24-h glycemic control and β-cell function in patients with type 2 diabetes. Diabetes Obes Metab 2007; 9: 186–93

    Article  PubMed  CAS  Google Scholar 

  80. Rosenstock J, Brazg R, Andryuk PJ, et al. Efficacy and safety of the dipeptidyl dipeptidase-4 inhibitor sitagliptin added to ongoing pioglitazone therapy in patients with type 2 diabetes: a 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther 2006; 28: 1556–68

    Article  PubMed  CAS  Google Scholar 

  81. Charbonnel B, Karasik A, Liu J, et al. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing metformin therapy in patients with type 2 diabetes inadequately controlled with metformin alone. Diabetes Care 2006; 29: 2638–43

    Article  PubMed  CAS  Google Scholar 

  82. Nauck MA, Meininger G, Sheng D, et al. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab 2007; 9: 194–205

    Article  PubMed  CAS  Google Scholar 

  83. Kleppinger EL, Helms K. The role of vildagliptin in the management of type 2 diabetes. Ann Pharmacother 2007; 41: 82432

    Article  CAS  Google Scholar 

  84. Balas B, Baig MR, Watson C, et al. The dipeptidyl peptidase IV inhibitor vildagliptin suppresses endogenous glucose production and enhances islet function after single-dose administration in type 2 diabetic patients. J Clin Endocrinol Metab 2007; 92(4): 1249–55

    Article  PubMed  CAS  Google Scholar 

  85. Ahren B, Gomis R, Standl E, et al. Twelve- and 52-week efficacy of the dipeptidyl peptidase IV inhibitor LAF237 in metformin-treated patients with type 2 diabetes. Diabetes Care 2004; 27: 2874–80

    Article  PubMed  CAS  Google Scholar 

  86. Dejager S, Lebeaut A, Couturier A, et al. Sustained reduction in HbA1c during one-year treatment with vildagliptin in patients with type 2 diabetes (T2DM) [abstract no. 120-OR]. Diabetes 2006; 55Suppl. 1: 29

    Google Scholar 

  87. Rosenstock J, Baron MA, Schweizer A, et al. Vildagliptin is as effective as rosiglitazone in lowering HbA1c but without weight gain in drug-naive patients with type 2 diabetes (T2DM) [abstract no. 557-P]. Diabetes 2006; 55Suppl. 1: 133

    Google Scholar 

  88. Garber A, Camisasca RP, Ehrsam E, et al. Vildagliptin added to metformin improves glycemic control and may mitigate metformin-induced GI side effects in patients with type 2 diabetes (T2DM) [abstract no. 121-OR]. Diabetes 2006; 55Suppl. 1: 29

    Google Scholar 

  89. Pratley RE, Rosenstock J, Pi-Sunyer F-X, et al. Management of type 2 diabetes in treatment naive elderly patients: benefits and risks of vildagliptin monotherapy. Diabetes Care 2007; 30(12): 3017–22

    Article  PubMed  CAS  Google Scholar 

  90. Pratley RE, Rosenstock J, Pi-Sunyer FX, et al. Benefit/risk assessment of vildagliptin in the elderly: pooled analysis of 5 monotherapy studies [abstract]. Diabetes 2007; 56Suppl. 1: A135

    Google Scholar 

  91. He Y-L, Sabo R, Campestrini J, et al. The effect of age, gender, and body mass index on the pharmacokinetics and pharmacodynamics of vildagliptin in healthy volunteers. Br J Clin Pharmacol 2008; 65(3): 338–46

    Article  PubMed  CAS  Google Scholar 

  92. Baron MA, Schweizer A, Couturier A, et al. Efficacy and tolerability of the DPP-4 inhibitor vildagliptin in drug naive patients with type 2 diabetes aged 65 years and older. J Am Geriatr Soc 2007; 55 Suppl.: 25–6

    Google Scholar 

  93. Augeri DJ, Robl JA, Betebenner DA, et al. Discovery and preclinical profile of saxagliptin (BMS-477118): a highly potent, long-acting, orally active dipeptidyl peptidase IV inhibitor for the treatment of type 2 diabetes. J Med Chem 2005; 48: 5025–37

    Article  PubMed  CAS  Google Scholar 

  94. Demuth HU, McIntosh CH, Pederson RA. Type 2 diabetes: therapy with dipeptidyl peptidase IV inhibitors. Biochim Biophys Acta 2005; 1751: 33–44

    Article  PubMed  CAS  Google Scholar 

  95. Qualmann C, Nauck MA, Holst JJ, et al. Glucagon-like peptide 1 [7-36 amide] secretion in response to luminal sucrose from the upper and lower gut: a study using alpha-glucosidase inhibition (acarbose). Scand J Gastroenterol 1995; 30: 892–6

    Article  PubMed  CAS  Google Scholar 

  96. Enç FY, Imeryüz N, Akin L, et al. Inhibition of gastric emptying by acarbose is correlated with GLP-1 response and accompanied by CCK release. Am J Physiol Gastrointest Liver Physiol 2001; 281: G752–63

    PubMed  Google Scholar 

  97. Seifarth C, Bergmann J, Holst JJ, et al. Prolonged and enhanced secretion of glucagon-like peptide 1 [7-36 amide] after oral sucrose due to alpha-glucosidase inhibition (acarbose) in type 2 diabetic patients. Diabet Med 1998; 15: 485–91

    Article  PubMed  CAS  Google Scholar 

  98. Lee A, Patrick P, Wishart J, et al. The effects of miglitol on glucagon-like peptide-1 secretion and appetite sensations in obese type 2 diabetics. Diabetes Obes Metab 2002; 4: 329–35

    Article  PubMed  CAS  Google Scholar 

  99. Hücking K, Kostic Z, Pox C, et al. α-Glucosidase inhibition (acarbose) fails to enhance secretion of glucagon-like peptide 1 [7–36 amide] and to delay gastric emptying in type 2 diabetic patients. Diabet Metab 2005; 22: 470–6

    Google Scholar 

  100. Hollander PA, Elbein SC, Hirsch IB, et al. Role of orlistat in the treatment of obese patients with type 2 diabetes: a 1-year randomized double-blind study. Diabetes Care 1998; 21: 1288–94

    Article  PubMed  CAS  Google Scholar 

  101. Damci T, Yalin S, Balci H, et al. Orlistat augments postprandial increases in glucagon-like peptide 1 in obese type 2 diabetic patients. Diabetes Care 2004; 27: 1077–80

    Article  PubMed  CAS  Google Scholar 

  102. DeLeon MJ, Chandurkar V, Albert SG, et al. Glucagon-like peptide-1 response to acarbose in elderly type 2 diabetic subjects. Diabetes Res Clin Pract 2002; 56: 101–6

    Article  PubMed  CAS  Google Scholar 

  103. Garber AJ, Foley JE, Banerji MA, et al. Effects of vildagliptin on glucose control in patients with type 2 diabetes inadequately controlled with suphonylurea. Diabetes Obes Metab. Epub 2008 Feb 18

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine and Metabolic Diseases, VI Divisione di Medicina Interna, Second University of Naples, Piazza Miraglia 2, I-80138, Napoli, Italy

    Angela M. Abbatecola &  Giuseppe Paolisso

  2. CNR Aging Branch, Padova, Italy

    Stefania Maggi

Authors
  1. Angela M. Abbatecola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefania Maggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Paolisso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Paolisso.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abbatecola, A.M., Maggi, S. & Paolisso, G. New Approaches to Treating Type 2 Diabetes Mellitus in the Elderly. Drugs Aging 25, 913–925 (2008). https://doi.org/10.2165/0002512-200825110-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/0002512-200825110-00002

Keywords

Search

Navigation