Older people with type 2 diabetes who control their sugar levels with certain commonly used drugs are at significantly increased risk of becoming hypoglycaemic (developing too low a blood sugar) compared with younger people with the condition.
This can be because older people can fail to recognise the warning symptoms of hypoglycaemia and also may have reduced kidney function, preventing their bodies from clearing the drugs from their system as efficiently as in younger people.
Many of the medications and treatments which can be used to lower blood sugar and prevent hyperglycaemia can go too far in older people, causing their sugar levels to plummet.
But the Birmingham study, published today (26 Oct) in the Lancet, shows that linagliptin, a drug which helps to promote the production of insulin and inhibits production of glucagon (hormones which respectively lower blood sugar and prevent the liver from overproducing sugar from the liver), could be used safely in older people to lower glucose.
This is because the drug only works when the blood sugar levels are rising or high and its actions “switch off” when blood sugars fall and normalise.
In addition, it is not excreted from the body through the kidneys so it is safe to use and still works well in people with reduced kidney function.
Hypoglycaemia in older people has a risk of severe consequences including falls, fractures, heart problems and even death and even if these things don’t occur it is extremely unpleasant for the patient.
Professor Anthony Barnett, Emeritus Professor of Medicine at the University of Birmingham and Consultant Physician at the Heart of England NHS Foundation Trust led the research.
He said: “Elderly individuals comprise a very large percent of people with Type 2 Diabetes; however, few glucose-lowering agents have been investigated in this group. This evidence gap hinders clinical decision-making as the risks and benefits of treatment may be unclear.
“We therefore believe that ours is a very important study in helping Health Care Professionals make informed choices about appropriate therapies for this challenging group of patients”