Science Brief | Why Are DPP-4 Inhibitors the “Reassuring Pill” for Glycemic Control in Older Patients with Diabetes?

China now has more than 35 million elderly patients with type 2 diabetes. These older adults often have multiple comorbidities, take a complex regimen of medications, exhibit impaired liver and kidney function, and are prone to muscle loss. Consequently, when selecting antidiabetic agents for this population, safety is far more critical than mere glycemic control. DPP-4 inhibitors, with their low risk of hypoglycemia, mild and renal-friendly profile, and lack of adverse effects on muscle mass, can be used as monotherapy or in combination with other drugs, making them the first-line choice for glycemic management in elderly patients with diabetes.

What are the characteristics of diabetes in older adults?

According to internationally accepted standards, patients with diabetes who are aged 65 years or older are classified as elderly patients with diabetes; this category includes both individuals who develop diabetes after the age of 65 and those who were diagnosed at a younger age and whose condition persists into old age.

Among older adults with diabetes, the most common subtype is “mild age-related diabetes (MARD).” These patients are typically older, of average body build, and exhibit relatively mild glycemic dysregulation. MARD accounts for as much as 45.1% of all older adults with diabetes in China; therefore, the selection of antidiabetic medications should be carefully tailored to the clinical characteristics of this predominant population.

For elderly people with diabetes, safety is paramount!

Older adults with diabetes are generally at high risk of hypoglycemia and exhibit blunted awareness of hypoglycemic episodes, making any such event potentially serious; moreover, they are a high-risk population for sarcopenia—defined as reduced muscle mass and limb weakness—with an estimated prevalence of 15% to 30% in China. Therefore, when selecting antidiabetic medications for older adults with diabetes, these two major safety concerns must be given top priority.

Why Are DPP-4 Inhibitors More Suitable for Older Patients with Diabetes?

As a first-line antidiabetic agent for older adults that is jointly recommended in both domestic and international guidelines, DPP-4 inhibitors offer numerous advantages that precisely align with the physiological needs of this population:

Stable blood sugar control, avoiding hypoglycemia:

It can intelligently regulate insulin secretion and, when used alone, virtually eliminates the risk of hypoglycemia, helping to maintain stable blood glucose levels in older adults with diabetes.

Liver- and kidney-friendly, with a light burden:

It has minimal impact on hepatic and renal function; even in the presence of mild abnormalities, frequent dose adjustments are not required.

Gentle on the body, soothing to the stomach:

It does not affect body weight and causes very few gastrointestinal adverse reactions, making it well-suited for the relatively weak gastrointestinal function of elderly individuals.

Protect muscle strength and slow down its decline:

It can reduce muscle loss, help older adults with diabetes maintain limb strength, and improve their quality of life.

In Japan, more than half of people with diabetes are aged 65 or older, and the prescription rate for DPP-4 inhibitors is as high as 60%, making them the most commonly used antidiabetic agents among elderly patients. The key to their widespread use lies in their safety and suitability, which closely align with the medication needs of this population.

Senglitin: A New Generation of Domestically Produced DPP-4 Inhibitor

Senglitin, a domestically developed and independently researched DPP-4 inhibitor of the new generation with high selectivity, achieves excellent glycemic control at only half the usual dose, while exhibiting a lower incidence of adverse events.

Clinical study data show that, among currently marketed DPP-4 inhibitors, the incidence of nasopharyngitis and headache ranges from 4% to 7%, while the incidence of upper respiratory tract infections ranges from 3% to 8%. In contrast, no cases of nasopharyngitis or headache were observed in the high-dose saxagliptin group, and the incidence of upper respiratory tract infections was less than 0.5%, with a safety profile comparable to that of placebo.

The launch of saxagliptin has provided Chinese elderly patients with diabetes a safer and more effective new option for glycemic control, thereby effectively safeguarding their health.