Discussion
In this post hoc, pooled analysis, sitagliptin was compared with sulfonylurea in elderly patients with T2DM. Compared with sulfonylurea, sitagliptin was associated with similar glycaemic efficacy, with decreases in the incidence of symptomatic hypoglycaemia and in body weight, and an increase in the proportion of patients meeting a composite end-point of HbA1c decrease of > 0.5%, no symptomatic hypoglycaemia and no increase in body weight. The results of these analyses in the subset of elderly patients are consistent with the results observed in overall populations of the individual studies.
In this analysis, the efficacy of sitagliptin and sulfonylureas was similar, while the two agents differed with regard to AEs of hypoglycaemia. This difference is likely because of the two agents' distinct mechanisms of action. The higher levels of insulin achieved during treatment with sulfonylureas may also be responsible for the weight gain associated with its use.
The incidence of hypoglycaemia in this analysis was based on reported AEs (defined as any episode with symptoms consistent with hypoglycaemia regardless of blood glucose levels) and not on measurements of blood glucose levels; therefore, it is possible that the number of hypoglycaemic episodes reported by patients was underestimated because of hypoglycaemia unawareness in elderly people.
In summary, in this analysis of elderly patients with T2DM, compared with sulfonylurea, sitagliptin provided similar glycaemic efficacy with less hypoglycaemia and with body weight loss.