Yu Dong-Ni, Qiu Lei, Ning Shang-Yong, Guo Li-Xin
1Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China, No. 1 DaHua Road, Dong Dan, Beijing, 100730 P. R. China.
2Department of Health Care, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China, Beijing, China.
Diabetol Metab Syndr. 2020 Apr 29;12:35. doi: 10.1186/s13098-020-00543-1. eCollection 2020.
The safety of hypoglycemic drugs should be paid more attention to in elderly patients with type 2 diabetes mellitus due to their concomitant diseases, physiological decline of liver and kidney function and cognitive decline. The aim of this study was to evaluate the efficacy and safety of DPP-4 inhibitors in elderly patients with type 2 diabetes mellitus.
From January 2010 to November 2018, 300 patients with type 2 diabetes mellitus who were over 60 years old were enrolled in the outpatient clinic of Geriatric Medical Center. Their medication records and follow-up medical records were used for retrospective analysis. The duration of treatment with DPP-4 inhibitors was more than 3 months. The changes of fasting blood glucose (GLU), glycosylated hemoglobin (HbA1C), body weight, body mass index (BMI) and liver and kidney function were compared before and after treatment.
The average age of 300 patients (212 males and 88 females) was 73.7 ± 9.1 years old, BMI was 26.5 ± 2.8 kg/m and the duration of diabetes was 10.7 ± 8.2 years. The results of retrospective analysis showed that HbA1C decreased by 0.27% after treatment (P < 0.001). In the group of DPP-4 inhibitors used for less than 12 months, there was no difference in liver transaminase (ALT and AST) between before and after treatment, whereas in the group of DPP-4 inhibitors used formore than 12 months, liver transaminase decreased statistically compared with after treatment (P < 0.001). The incidence of fatty liver in elderly diabetic patients decreased after using DPP-4 inhibitors. There was no significant change in serum creatinine level and creatinine clearance rate in elderly patients with type 2 diabetes mellitus after treatment of DPP-4 inhibitor. In addition, the body weight and BMI of the patients decreased significantly (P < 0.001). No hypoglycemic reaction and gastrointestinal discomfort were found in the medical records.
After DPP-4 inhibitors were used in elderly patients with type 2 diabetes mellitus, the elevated glycosylated hemoglobin could be controlled with improved safety of liver and kidney, and might have the effect of weight loss.
老年2型糖尿病患者常伴有多种疾病，肝肾功能生理性衰退以及认知功能下降，因此降糖药物的安全性更应受到关注。本研究旨在评估二肽基肽酶-4（DPP-4）抑制剂在老年2型糖尿病患者中的疗效及安全性。
选取2010年1月至2018年11月期间，老年医学中心门诊收治的300例年龄大于60岁的2型糖尿病患者，利用其用药记录及随访病历进行回顾性分析。DPP-4抑制剂治疗时长超过3个月，比较治疗前后空腹血糖（GLU）、糖化血红蛋白（HbA1C）、体重、体重指数（BMI）以及肝肾功能的变化。
300例患者（男性212例，女性88例）平均年龄73.7±9.1岁，BMI为26.5±2.8kg/m，糖尿病病程为10.7±8.2年。回顾性分析结果显示，治疗后糖化血红蛋白下降了0.27%（P<0.001）。使用DPP-4抑制剂不足12个月的患者组，治疗前后肝转氨酶（ALT和AST）无差异；而使用DPP-4抑制剂超过12个月的患者组，与治疗后相比肝转氨酶有统计学意义的下降（P<0.001）。老年糖尿病患者使用DPP-4抑制剂后脂肪肝发病率降低。2型糖尿病老年患者经DPP-4抑制剂治疗后，血清肌酐水平及肌酐清除率无显著变化。此外，患者体重及BMI显著下降（P<0.001）。病历中未发现低血糖反应及胃肠道不适情况。
老年2型糖尿病患者使用DPP-4抑制剂后，可控制糖化血红蛋白升高，改善肝肾安全性，且可能具有减重作用。
