M Angelyn Bethel1, Samuel S Engel2, Jennifer B Green3, Zhen Huang3, Robert G Josse4, Keith D Kaufman2, Eberhard Standl5, Shailaja Suryawanshi2, Frans Van de Werf6, Darren K McGuire7, Eric D Peterson3, Rury R Holman8. 1. Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K. angelyn.bethel@dtu.ox.ac.uk. 2. Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. 4. St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 5. Munich Diabetes Research Group e.V., Helmholtz Centre, Neuherberg, Germany. 6. Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. 7. Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX. 8. Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K.
Abstract
OBJECTIVE: Limited data exist regarding safety and efficacy of antihyperglycemic drugs in older patients with type 2 diabetes. The Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) was a randomized, double-blind, placebo-controlled trial assessing the impact of sitagliptin on a primary composite outcome of cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, or unstable angina hospitalizations in patients with type 2 diabetes (HbA1c ≥6.5% [48 mmol/mol] and ≤8.0% [64 mmol/mol]) and cardiovascular disease. We analyzed baseline characteristics and clinical outcomes for TECOS participants aged ≥75 years. RESEARCH DESIGN AND METHODS: Clinical and safety event summaries are presented for older versus younger participants and for the treatment groups within the older cohort. RESULTS: Of 14,351 participants with age recorded, 2,004 (14%) were≥75 years old (mean age 78.3 years [SD 3.1]), with 68% men and type 2 diabetes duration median 12.0 years (IQR 7, 21). During 2.9 years median follow-up, older participants had higher rates of the primary outcome (6.46 vs. 3.67 events per 100 person-years; hazard ratio 1.72 [95% CI 1.52-1.94]), death (2.52 [2.20-2.89]), severe hypoglycemia (1.53 [1.15-2.03]), and fractures (1.84 [1.44-2.35]). In the older cohort, sitagliptin did not significantly impact the primary composite (1.10 [0.89-1.36]), death (1.05 [0.83-1.32]), heart failure hospitalization (0.99 [0.65-1.49]), severe hypoglycemia (1.03 [0.62-1.71]), rates of acute pancreatitis and pancreatic cancer, or serious adverse events. CONCLUSIONS: Among older patients with well-controlled type 2 diabetes and cardiovascular disease, sitagliptin had neutral effects on cardiovascular risk and raised no significant safety concerns.
RCT Entities:
OBJECTIVE: Limited data exist regarding safety and efficacy of antihyperglycemic drugs in older patients with type 2 diabetes. The Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) was a randomized, double-blind, placebo-controlled trial assessing the impact of sitagliptin on a primary composite outcome of cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, or unstable angina hospitalizations in patients with type 2 diabetes (HbA1c ≥6.5% [48 mmol/mol] and ≤8.0% [64 mmol/mol]) and cardiovascular disease. We analyzed baseline characteristics and clinical outcomes for TECOSparticipants aged ≥75 years. RESEARCH DESIGN AND METHODS: Clinical and safety event summaries are presented for older versus younger participants and for the treatment groups within the older cohort. RESULTS: Of 14,351 participants with age recorded, 2,004 (14%) were ≥75 years old (mean age 78.3 years [SD 3.1]), with 68% men and type 2 diabetes duration median 12.0 years (IQR 7, 21). During 2.9 years median follow-up, older participants had higher rates of the primary outcome (6.46 vs. 3.67 events per 100 person-years; hazard ratio 1.72 [95% CI 1.52-1.94]), death (2.52 [2.20-2.89]), severe hypoglycemia (1.53 [1.15-2.03]), and fractures (1.84 [1.44-2.35]). In the older cohort, sitagliptin did not significantly impact the primary composite (1.10 [0.89-1.36]), death (1.05 [0.83-1.32]), heart failure hospitalization (0.99 [0.65-1.49]), severe hypoglycemia (1.03 [0.62-1.71]), rates of acute pancreatitis and pancreatic cancer, or serious adverse events. CONCLUSIONS: Among older patients with well-controlled type 2 diabetes and cardiovascular disease, sitagliptin had neutral effects on cardiovascular risk and raised no significant safety concerns.
Authors: Stacey A Seggelke; Mark C Lindsay; Ingrid Hazlett; Rebecca Sanagorski; Robert H Eckel; Cecilia C Low Wang Journal: Curr Diab Rep Date: 2017-08 Impact factor: 4.810