In elderly patients with type 2 or non-insulin dependent diabetes, treatment with the short-acting drug repaglinide (NovoNorm) may be safer than that with the longer-acting drug, glibenclamide (glyburide), Italian researchers report.

In particular, there are far fewer episodes of low blood sugar, what doctors call hypoglycemia, with NovoNorm, they found.

“The major clinical implication of our study,” said Dr. Francesco Purrello, “is that short-acting hypoglycemic drugs, such as repaglinide, should be used in elderly individuals instead of long-acting compounds, such as glyburide, to decrease the risk of hypoglycemic reactions that may be extremely dangerous in these patients.”

According to Purrello, “despite the disproportionate number of elderly individuals with diabetes mellitus, the treatment of these patients is often inadequate and the therapeutic goals undefined, mainly because of the fear of severe hypoglycemic events.”

“The reverse side of the coin,” he added, “is that, also in elderly patients, poor metabolic control increases the risk of cardiovascular disease and stroke.”

To determine whether a short-acting agent might be safer than a long-acting one, the researchers conducted a 24-week crossover study of 90 diabetic patients aged 65 years or older.

They were randomized to take NovoNorm at mealtime or twice-daily glibenclamide (Euglucon).

The frequency of low blood sugar episodes was significantly lower with NovoNorm than with Euglucon, at 0.38 versus 1.4 episodes per 12-week period per patient.

This, say the investigators, amounted to a 51 percent risk reduction. Results were similar in a subgroup of patients aged 75 years or older.

SOURCE: Diabetes Care August 2006.