Comparative safety of dipeptidyl peptidase‐4 inhibitors and sulfonylureas among frail older adults. Issue 10 (21st July 2021)

• Record Type: Journal Article
• Authors: Zullo, Andrew R.; Smith, Robert J.; Gutman, Roee; Kohler, Bianca; Duprey, Matthew S.; Berry, Sarah D.; Munshi, Medha N.; Dore, David D.
• Is Part Of: Journal of the American Geriatrics Society. Volume 69:Issue 10(2021)
• Page Start: 2923
• Page End: 2930
• Publication Date: 2021-07-21
• Subjects: diabetes mellitus -- dipeptidyl‐peptidase IV inhibitors -- frailty -- nursing homes -- sulfonylurea compounds; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.17371
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract: Background: Studies comparing dipeptidyl peptidase‐4 inhibitors (DPP4Is) to sulfonylureas (SUs) are unavailable for frail older adults, especially nursing home (NH) residents. We examined the effects of DPP4Is versus SUs on severe adverse glycemic events, cardiovascular events, and death among NH residents. Methods: We conducted a national retrospective cohort study of long‐stay NH residents aged ≥65 years using 2008–2010 national US Minimum Data Set clinical assessment data and linked Medicare claims. Exposure was new DPP4I versus new SU use assessed via Medicare Part D drug claims. One‐year outcomes were severe hypoglycemia, severe hyperglycemia, acute myocardial infarction (AMI), heart failure (HF), major adverse cardiovascular events plus HF (MACE+HF), and death. We compared outcomes after propensity score matching using Cox proportional hazards regression models. Results: The cohort ( N = 2016) had a mean (SD) age of 81 (8.1) years and was 72% female. Compared with SU users, DPP4I users had a lower 1‐year rate of severe hypoglycemic events (HR = 0.57, 95% CI 0.34–0.94), but statistically similar rates of severe hyperglycemic events (HR = 0.94, 95% CI 0.52–1.72), AMI (HR = 0.76, 95% CI 0.44–1.30), HF (HR = 1.01, 95% CI 0.79–1.30), MACE+HF (HR = 0.90, 95% CI 0.72–1.12), and death (HR = 0.97, 95% CI 0.86–1.10). Conclusions: DPP4Is should be a preferred treatment option over SUs for NH residents and other frail older adults given the importance of avoiding hypoglycemia.