The role of DPP-4 inhibitors in achieving glycemic control and the effect on aging processes in patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is characterized by annually progressive morbidity, the development of late disabling micro- and macrovascular complications, and an increased incidence of chronic heart failure. At the same time, the development of medicine has naturally led to an increase in the average life expectancy of the population in developed countries and an increase in the number of elderly and senile people. All this puts a tremendous burden on the healthcare system and complicates the task of improving the quality of life of patients with T2DM. As is known, T2DM in the elderly significantly increases the risk of disabling complications and mortality. Dipeptidyl peptidase type 4 inhibitors (iDPP-4) have occupied one of the key places in the strategy of T2DM therapy in elderly patients, and in the Algorithms of specialized medical care for patients with diabetes mellitus they are noted as preferred for residential patients. However, according to the Federal Register of Patients with Diabetes Mellitus, the proportion of patients taking iDPP-4 decreases with increasing duration of the disease. In elderly patients, a number of reasons contribute to this. Probably, this is the lack of preferential gliptin coverage in a number of regions of Russia, experts' concerns about the insufficient hypoglycemic effectiveness of iDPP-4 with a decrease in beta cell function with an increase in the length of service of T2DM, and often unjustified transfer of patients to basic insulin therapy, which dictates the need to cancel iDPP-4. This review will present the features of the course and tactics of treatment of T2DM in the elderly and consider in detail the efficacy, safety and potential pleiotropic effects of iDPP-4 in this category of patients. Special attention will be paid to the first iDPP-4 registered in the world, sitagliptin.

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