Cargando…
Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing
BACKGROUND: Preventable drug-related hospital admissions can be associated with drugs used in diabetes and the benefits of strict diabetes control may not outweigh the risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of DPP-4 inhibitors in...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647559/ https://www.ncbi.nlm.nih.gov/pubmed/29047372 http://dx.doi.org/10.1186/s12877-017-0571-8 |
_version_ | 1783272270094925824 |
---|---|
author | Schott, Gisela Martinez, Yolanda V Ediriweera de Silva, R. Erandie Renom-Guiteras, Anna Vögele, Anna Reeves, David Kunnamo, Ilkka Marttila-Vaara, Minna Sönnichsen, Andreas |
author_facet | Schott, Gisela Martinez, Yolanda V Ediriweera de Silva, R. Erandie Renom-Guiteras, Anna Vögele, Anna Reeves, David Kunnamo, Ilkka Marttila-Vaara, Minna Sönnichsen, Andreas |
author_sort | Schott, Gisela |
collection | PubMed |
description | BACKGROUND: Preventable drug-related hospital admissions can be associated with drugs used in diabetes and the benefits of strict diabetes control may not outweigh the risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of DPP-4 inhibitors in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project. METHODS: Systematic review using a staged approach which searches for systematic reviews and meta-analyses first, then individual studies only if prior searches were inconclusive. The target population were older people (≥65 years old) with type 2 diabetes. We included studies reporting on the efficacy and/or safety of DPP-4 inhibitors for the management of type 2 diabetes. Studies were included irrespective of DPP-4 inhibitors prescribed as monotherapy or in combination with any other drug for the treatment of type 2 diabetes. The target intervention was DPP-4 inhibitors compared to placebo, no treatment, other drugs to treat type 2 diabetes or a non-pharmacological intervention. RESULTS: Thirty studies (reported in 33 publications) were included: 1 meta-analysis, 17 intervention studies and 12 observational studies. Sixteen studies were focused on older adults and 14 studies reported subgroup analyses in participants ≥65, ≥70, or ≥75 years. Comorbidities were reported by 26 studies and frailty or functional status by one study. There were conflicting findings regarding the effectiveness of DPP-4 inhibitors in older adults. In general, DPP-4 inhibitors showed similar or better safety than placebo and other antidiabetic drugs. However, these safety data are mainly based on short-term outcomes like hypoglycaemia in studies with HbA1c control levels recommended for younger people. One recommendation was developed advising clinicians to reconsider the use of DPP-4 inhibitors for the management of type 2 diabetes in older adults with HbA1c <8.5% because of scarce data on clinically relevant benefits of their use. Twenty-two of the included studies were funded by pharmaceutical companies and authored or co-authored by employees of the sponsor. CONCLUSIONS: Other than the surrogate endpoint of improved glycaemic control, data on clinically relevant benefits of DPP-4 inhibitors in the treatment of type 2 diabetes mellitus in older adults is scarce. DPP-4 inhibitors might have a lower risk of hypoglycaemia compared to other antidiabetic drugs but data show conflicting findings for long-term benefits. Further studies are needed that evaluate the risks and benefits of DPP-4 inhibitors for the management of type 2 diabetes mellitus in older adults, using clinically relevant outcomes and including representative samples of older adults with information on their frailty status and comorbidities. Studies are also needed that are independent of pharmaceutical company involvement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12877-017-0571-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5647559 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-56475592017-10-26 Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing Schott, Gisela Martinez, Yolanda V Ediriweera de Silva, R. Erandie Renom-Guiteras, Anna Vögele, Anna Reeves, David Kunnamo, Ilkka Marttila-Vaara, Minna Sönnichsen, Andreas BMC Geriatr Systematic Review BACKGROUND: Preventable drug-related hospital admissions can be associated with drugs used in diabetes and the benefits of strict diabetes control may not outweigh the risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of DPP-4 inhibitors in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project. METHODS: Systematic review using a staged approach which searches for systematic reviews and meta-analyses first, then individual studies only if prior searches were inconclusive. The target population were older people (≥65 years old) with type 2 diabetes. We included studies reporting on the efficacy and/or safety of DPP-4 inhibitors for the management of type 2 diabetes. Studies were included irrespective of DPP-4 inhibitors prescribed as monotherapy or in combination with any other drug for the treatment of type 2 diabetes. The target intervention was DPP-4 inhibitors compared to placebo, no treatment, other drugs to treat type 2 diabetes or a non-pharmacological intervention. RESULTS: Thirty studies (reported in 33 publications) were included: 1 meta-analysis, 17 intervention studies and 12 observational studies. Sixteen studies were focused on older adults and 14 studies reported subgroup analyses in participants ≥65, ≥70, or ≥75 years. Comorbidities were reported by 26 studies and frailty or functional status by one study. There were conflicting findings regarding the effectiveness of DPP-4 inhibitors in older adults. In general, DPP-4 inhibitors showed similar or better safety than placebo and other antidiabetic drugs. However, these safety data are mainly based on short-term outcomes like hypoglycaemia in studies with HbA1c control levels recommended for younger people. One recommendation was developed advising clinicians to reconsider the use of DPP-4 inhibitors for the management of type 2 diabetes in older adults with HbA1c <8.5% because of scarce data on clinically relevant benefits of their use. Twenty-two of the included studies were funded by pharmaceutical companies and authored or co-authored by employees of the sponsor. CONCLUSIONS: Other than the surrogate endpoint of improved glycaemic control, data on clinically relevant benefits of DPP-4 inhibitors in the treatment of type 2 diabetes mellitus in older adults is scarce. DPP-4 inhibitors might have a lower risk of hypoglycaemia compared to other antidiabetic drugs but data show conflicting findings for long-term benefits. Further studies are needed that evaluate the risks and benefits of DPP-4 inhibitors for the management of type 2 diabetes mellitus in older adults, using clinically relevant outcomes and including representative samples of older adults with information on their frailty status and comorbidities. Studies are also needed that are independent of pharmaceutical company involvement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12877-017-0571-8) contains supplementary material, which is available to authorized users. BioMed Central 2017-10-16 /pmc/articles/PMC5647559/ /pubmed/29047372 http://dx.doi.org/10.1186/s12877-017-0571-8 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Systematic Review Schott, Gisela Martinez, Yolanda V Ediriweera de Silva, R. Erandie Renom-Guiteras, Anna Vögele, Anna Reeves, David Kunnamo, Ilkka Marttila-Vaara, Minna Sönnichsen, Andreas Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing |
title | Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing |
title_full | Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing |
title_fullStr | Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing |
title_full_unstemmed | Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing |
title_short | Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing |
title_sort | effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647559/ https://www.ncbi.nlm.nih.gov/pubmed/29047372 http://dx.doi.org/10.1186/s12877-017-0571-8 |
work_keys_str_mv | AT schottgisela effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT martinezyolandav effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT ediriweeradesilvarerandie effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT renomguiterasanna effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT vogeleanna effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT reevesdavid effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT kunnamoilkka effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT marttilavaaraminna effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing AT sonnichsenandreas effectivenessandsafetyofdipeptidylpeptidase4inhibitorsinthemanagementoftype2diabetesinolderadultsasystematicreviewanddevelopmentofrecommendationstoreduceinappropriateprescribing |