Diabetology Xagena

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Type 2 diabetes mellitus: individualised treatment targets for elderly patients using Vildagliptin add-on or lone therapy

Guidelines suggest setting individualised targets for glycaemic control in elderly patients with type 2 diabetes, despite no evidence.
The aim of the study ( INTERVAL ) was to assess the feasibility of setting and achieving individualised targets over 24 weeks along with conventional HbA1c reduction using Vildagliptin ( Galvus ) versus placebo.

In this multinational, double-blind, 24 week study, researchers enrolled drug-naive or inadequately controlled ( glycosylated haemoglobin A1c [ HbA1c ] greater than or equal to 7.0% to less than or equal to 10.0% ) patients with type 2 diabetes aged 70 years or older from 45 outpatient centres in Europe.

Investigators set individualised treatment targets on the basis of age, baseline HbA1c, comorbidities, and frailty status before a validated automated system randomly assigned patients ( 1:1 ) to Vildagliptin ( 50 mg once or twice daily as per label ) or placebo.

Coprimary efficacy endpoints were proportion of patients reaching their investigator-defined HbA1c target and HbA1c reduction from baseline to study end.

During the period 2010-2012, researchers randomly assigned 139 patients each to the Vildagliptin and placebo groups. 37 ( 27% ) of 137 patients in the placebo group achieved their individualised targets by education and interactions with the study team alone and 72 ( 52.6% ) of 137 patients achieved their target in the Vildagliptin group ( adjusted odds ratio, OR=3.16; p less than 0.0001 ).

This finding was accompanied by a clinically relevant 0.9% reduction in HbA1c from a baseline of 7.9% with Vildagliptin and a between-group difference of -0.6% ( p less than 0.0001 ).

The overall safety and tolerability was similar in the Vildagliptin and placebo groups, with low incidence of hypoglycaemia and no emergence of new safety signals.

This study is the first to introduce and show the feasibility of using individualised HbA1c targets as an endpoint in any type 2 diabetes population.
Individualised glycaemic target levels are achievable with Vildagliptin without any tolerability issues in the elderly type 2 diabetes population. ( Xagena )

Strain WD et al, The Lancet 2013; 382: 409-416