DPP-4 inhibitors a suitable second-line treatment for young-onset diabetes

In the treatment of patients with young-onset diabetes, adding dipeptidyl peptidase-4 (DPP-4) inhibitors contributes to lower risks of hospitalization and death compared with sulfonylureas (SUs), according to a study.

The study included 7,257 patients taking second-line oral antidiabetic drugs (OADs) following initial metformin therapy. There were five categories of add-on OADs used, namely alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors, SUs, and thiazolidinediones.

In multivariable Cox regression models that used sulfonylureas (SUs) as reference, DPP-4 inhibitors performed well as a second-line OAD in the treatment of young-onset diabetes.

Specifically, metformin plus DPP-4 inhibitors reduced the risk of all-cause hospitalization by 38 percent (hazard ratio [HR], 0.62, 95 percent confidence interval [CI], 0.52–0.73), cardiovascular hospitalization by 51 percent (HR, 0.49, 95 percent CI, 0.29–0.85), noninfection hospitalization by 36 percent (HR, 0.64, 95 percent CI, 0.54–0.76), and all-cause mortality by 50 percent (HR, 0.50, 95 percent CI, 0.27–0.92) relative to metformin plus SU.

The analysis was controlled for confounders such as baseline characteristics, comorbidities, duration of diabetes, and drug use.

Patients with young-onset diabetes are at higher risk of morbidity and mortality compared with those with late-onset diabetes. The findings suggest that DPP-4 inhibitors may be the preferred second-line option in the management of diabetes in this population.