Linagliptin in the frail elderly diabetic patient

Abstract

The elderly patient with diabetes represents the paradigmatic example of a "patient-centered approach" in the therapeutic strategy of diabetic disease. Treatment of the elderly with diabetes is complicated by significant clinical and functional heterogeneity: in these patients, comorbidities and polytherapies are extremely common and the risk of interactions and/or adverse effects becomes relevant. In this particular population it is therefore important to identify a less restrictive glycemic target, although it is not acceptable to consider hyperglycemia in the elderly as a physiological condition. Due to their efficacy, high tolerability, ease of use and cardiovascular safety profile, dipeptidyl peptidase IV (DPP-4) inhibitors are a preferred treatment option rather than sulfonylureas and glinides in elderly patients that are not adequately controlled with metformin alone or are intolerant or have contraindications to metformin. We describe the case of an 82-year-old patient with type 2 diabetes mellitus for about 25 years, with a sedentary lifestyle due to a partial motor difficulty linked to instability. For over 15 years it has also suffered from chronic ischemic heart disease, arterial hypertension and chronic renal failure. The use of linagliptin in this patient therapy confirms the known tolerability ease of use and safety profile of the drug. The data obtained support how it is possible to safely and independently manage the therapy with linagliptin in combination with insulin, which is therefore a valid therapeutic option in elderly patients with high cardiovascular risk undergoing multiple treatments (Diabetology).

Keywords

• Type 2 diabetes
• Frail elderly
• Chronic renal insufficiency
• Linagliptin
• Polytherapy