Use of metformin and vildagliptin for treatment of type 2 diabetes in the elderly

Abstract

Background

The aim of this study was to describe the clinical (treatment adherence, metabolic control, hypoglycemia, and macrovascular complications) and economic (resource use and costs) consequences of using a combination of metformin + vildagliptin to treat type 2 diabetes in elderly patients seen in daily clinical practice.

Methods

We conducted a multicenter, retrospective, observational study that included patients aged ≥65 years treated with metformin who started a second oral antidiabetic therapy during the years 2008–2009. There were two groups of patients: a study group receiving metformin + vildagliptin and a reference group receiving metformin + other oral antidiabetics (sulfonylureas or glitazones). The main measures were comorbidity, compliance/persistence, metabolic control (glycosylated hemoglobin <7%), complications (hypoglycemic, macrovascular), and total costs. The patients were followed for 2 years.

Results

We recruited 987 patients (49.1% male) of mean age 74.2 years. There were 270 (27.4%) patients in the metformin + vildagliptin group and 717 (72.6%) in the reference group. Vildagliptin-treated patients had significantly (P<0.05) improved compliance (68.3% versus 62.5%, respectively), persistence (61.5% versus 55.1%), and metabolic control (63.3% versus 57.6%). They also had lower rates of hypoglycemia (17.4% versus 42.8%) and cardiovascular events (4.4% versus 8.6%) and lower total costs (€2,544 versus €2,699, P<0.05).

Conclusion

Patients treated with metformin and vildagliptin showed better adherence and metabolic control and lower rates of hypoglycemia, resulting in lower health care costs for the national health system.

Keywords:

• vildagliptin
• diabetes
• metabolic control
• hypoglycemia
• cardiovascular events
• health costs

Author contributions

ASM conceived of and designed the manuscript. Data were collected by ASM and RNA. ASM performed the statistical analysis. Both authors participated in interpretation of the data, and in the drafting, revision, and approval of the final manuscript.

Disclosure

This study was funded by Novartis. ASM was paid by Novartis to develop the manuscript. The statistical analysis was performed by ASM and funded by Novartis. The other author reports no competing interests in this work. Novartis had no role in the study design, data collection or analysis, the decision to publish, or preparation of the manuscript.