Comparative safety of dipeptidyl peptidase-4 inhibitors and sulfonylureas among frail older adults

Andrew R. Zullo; Robert J. Smith; Roee Gutman; Bianca Kohler; Matthew S. Duprey; Sarah D. Berry; Medha N. Munshi; David D. Dore

doi:10.1111/jgs.17371

Comparative safety of dipeptidyl peptidase-4 inhibitors and sulfonylureas among frail older adults

Andrew R. Zullo
, Robert J. Smith
, Roee Gutman
, Bianca Kohler
, Matthew S. Duprey
, Sarah D. Berry
, Medha N. Munshi
, David D. Dore

Pharmacy Practice and Science

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

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.

Original language	English
Pages (from-to)	2923-2930
Number of pages	8
Journal	Journal of the American Geriatrics Society
Volume	69
Issue number	10
DOIs	https://doi.org/10.1111/jgs.17371
State	Published - Oct 2021

Bibliographical note

Publisher Copyright:
© 2021 The American Geriatrics Society.

Funding

Dr. Zullo is a U.S. Government employee; the views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. This study was supported by grants R01AG045441, RF1AG061221, R01AG065722, and R21AG061632 from the National Institute on Aging (NIA) and by grant U54GM1156775 from the National Institute of General Medical Sciences (NIGMS), which funds Dr. Zullo and Advance Clinical and Translational Research (Advance‐CTR). Dr. Zullo was also supported by a Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Health Services Research and Development. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr. Zullo is a U.S. Government employee; the views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. This study was supported by grants R01AG045441, RF1AG061221, R01AG065722, and R21AG061632 from the National Institute on Aging (NIA) and by grant U54GM1156775 from the National Institute of General Medical Sciences (NIGMS), which funds Dr. Zullo and Advance Clinical and Translational Research (Advance-CTR). Dr. Zullo was also supported by a Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Health Services Research and Development. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funders	Funder number
Advance Clinical and Translational Research
National Institute on Aging	R01AG065722, U54GM1156775, R21AG061632, RF1AG061221, R01AG045441
National Institute of General Medical Sciences DP2GM119177 Sophie Dumont National Institute of General Medical Sciences
Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

diabetes mellitus
dipeptidyl-peptidase IV inhibitors
frailty
nursing homes
sulfonylurea compounds

ASJC Scopus subject areas

Geriatrics and Gerontology

Access to Document

10.1111/jgs.17371

Cite this

@article{367bb56bed0f4f24b0455a475674a160,

title = "Comparative safety of dipeptidyl peptidase-4 inhibitors and sulfonylureas among frail older adults",

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.",

keywords = "diabetes mellitus, dipeptidyl-peptidase IV inhibitors, frailty, nursing homes, sulfonylurea compounds",

author = "Zullo, \{Andrew R.\} and Smith, \{Robert J.\} and Roee Gutman and Bianca Kohler and Duprey, \{Matthew S.\} and Berry, \{Sarah D.\} and Munshi, \{Medha N.\} and Dore, \{David D.\}",

note = "Publisher Copyright: {\textcopyright} 2021 The American Geriatrics Society.",

year = "2021",

month = oct,

doi = "10.1111/jgs.17371",

language = "English",

volume = "69",

pages = "2923--2930",

number = "10",

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TY - JOUR

T1 - Comparative safety of dipeptidyl peptidase-4 inhibitors and sulfonylureas among frail older adults

AU - Zullo, Andrew R.

AU - Smith, Robert J.

AU - Gutman, Roee

AU - Kohler, Bianca

AU - Duprey, Matthew S.

AU - Berry, Sarah D.

AU - Munshi, Medha N.

AU - Dore, David D.

PY - 2021/10

Y1 - 2021/10

N2 - 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.

AB - 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.

KW - diabetes mellitus

KW - dipeptidyl-peptidase IV inhibitors

KW - frailty

KW - nursing homes

KW - sulfonylurea compounds

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UR - https://www.scopus.com/pages/publications/85110947175#tab=citedBy

U2 - 10.1111/jgs.17371

DO - 10.1111/jgs.17371

M3 - Article

C2 - 34291453

AN - SCOPUS:85110947175

SN - 0002-8614

VL - 69

SP - 2923

EP - 2930

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

IS - 10

ER -

Comparative safety of dipeptidyl peptidase-4 inhibitors and sulfonylureas among frail older adults

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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