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This section of the website is for UK healthcare professionals only. If you are not a healthcare professional, please click here.

Updated on 15/03/2018

DIABETES
An over-65 year old diabetes patient enjoying their new phase of life

Renal impairment, CV issues and hypoglycaemia can all be of concern

As people with diabetes grow older, they are more likely to present with comorbidities such as chronic kidney disease or increased cardiovascular risk.1,2 JANUVIA offers effective treatment,3-6 alongside an established safety profile7 and low risk of hypoglycaemia.4

Patient anxiety can increase with age

JANUVIA can help you support people with T2DM and additional complications

JANUVIA effectively lowers HbA1c, even in people with renal impairment3-6

The need to manage risks around renal damage in people with type 2 diabetes while still providing effective results can affect your choice of treatment.

In three different clinical studies, JANUVIA demonstrated efficacy in people with different levels of renal function.*4-6

*Dose reductions are required depending on the level of renal impairment. Doses in renal impairment are 100mg for a GFR ≥45 to <90 ml/min, 50mg for a GFR ≥30 to <45 ml/min or 25mg for a GFR <30 ml/min. As there is a dose adjustment based upon renal function, assessment of renal function is recommended prior to the indication of JANUVIA and periodically thereafter. Please refer to the JANUVIA SPC for dosage details.3

JANUVIA achieves HbA1c reduction in patients across the spectrum of impaired renal function, as shown in three different clinical studies4-6

Graph showing change in HbA1c from baseline in patients at different stages of renal function, using either glipizide + metformin or JANUVIA + metformin

*Dose of JANUVIA in this study was 50 mg or 25 mg daily depending on renal impairment
**Adjusted based on glycaemic control to a 10 mg b.d. maximum dose.
Up-titrated to a potential maximum of 20 mg/d.
‡Patients on dialysis not included.

Adapted from Nauck et al, 2007; Ferreira et al, 2013; Ferreira et al, 2013

Study design

Adjusting JANUVIA dose for people with renal impairment

JANUVIA is available in three doses as dosing will require adjustment based on renal function.*3

*Assessment of renal function is recommended prior to initiation of therapy and periodically during treatment. JANUVIA may be administered without regard for timing of dialysis3
ESRD = End-stage renal disease

Offer people aged 65 and over with T2DM the reassurance of an established renal and CV safety profile7

Many older people with T2DM may experience renal damage that can lead to increased cardiovascular risk.1 TECOS explored the safety of JANUVIA in the longest CV safety trial of DPP-4 inhibitors in type 2 diabetes to date vs usual care alone.7

Randomised double blind CV safety trial7

Over 14,000 patients7

3 years median follow up7

When added to usual care, JANUVIA demonstrated:

No increased CV risk7
Primary composite cardiovascular outcome was cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, or hospitalisation for unstable angina (PP HR 0.98 (95% CI: 0.88-1.09), p<0.001 for non-inferiority vs placebo, n=14,523)7

No increased risk of hospitalisation for heart failure7
Hospitalisation for heart failure was a secondary endpoint. (ITT HR 1.00 (95% CI: 0.83-1.20), p=0.98)7

PP: per protocol; HR: hazard ratio; CI: confidence interval; ITT: intention-to-treat-population.

Study design

JANUVIA plus metformin offers a low incidence of hypoglycaemia4

Day and night-time hypoglycaemia can be a real concern for people over 65 years old with T2DM, affecting daily activities such as driving.8 JANUVIA can help.

Over a 52 week period, less than 5% of patients on JANUVIA plus metformin experienced a hypoglycaemic event vs 32% of patients on SU plus metformin.4

Hypoglycaemic events with JANUVIA plus metformin vs SU plus metformin.4

Graph showing percentage of patients with hypoglycaemic events with JANUVIA plus metformin versus SU plus metformin

Adapted from Nauck et al, 2007

Study design

Helping people over 65 years old enjoy a new phase of life

TREND UK, a group of nurses working in diabetes care, have developed simple, reader-friendly materials specifically designed to help you support older people in managing escalating comorbidities associated with type 2 diabetes. You can download all of these below:

Download TREND leaflets here

Related content

 

References

  1. Bailey RA et al. BMC Research Notes. 2014;7:415
  2. Iglay K et al. Curr Med Res Opin. 2016;32(7):1243-52.
  3. JANUVIA Summary of Product Characteristics.
  4. Nauck MA et al. Diabetes Obes Metab. 2007; 9(2): 194–205.
  5. Ferreira JCA et al. Diabetes Care. 2013;36(5):1067–1073.
  6. Ferreira JCA et al. Am J Kidney Dis. 2013;61(4):579–587.
  7. Green JB et al. N Engl J Med. 2015;373(3):232–242.
  8. Quandt SA et al. J Appl Gerontol. 2013;32(7):783–803.

Supporting documentation

100 mg
Prescribing Information | Summary of Product Characteristics | Patient Information Leaflet

50 mg
Prescribing Information | Summary of Product Characteristics | Patient Information Leaflet

25 mg
Prescribing Information | Summary of Product Characteristics | Patient Information Leaflet

DIAB-1247350-0027 | Date of Preparation: March 2018