Вилдаглиптин у пожилых пациентов с сахарным диабетом 2-го типа: баланс эффективности и безопасности

Васильева В.А., Марченкова Л.А. Вилдаглиптин у пожилых пациентов с сахарным диабетом 2-го типа: баланс эффективности и безопасности. Consilium Medicum. 2026;28(4):247–252. DOI: 10.26442/20751753.2026.4.203658

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Vasileva VA, Marchenkova LA. Vildagliptin in elderly patients with type 2 diabetes: a balance of efficacy and safety. A review. Consilium Medicum. 2026;28(4):247–252. DOI: 10.26442/20751753.2026.4.203658

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Аннотация

Сахарный диабет 2-го типа (СД 2) широко распространен среди лиц пожилого возраста и характеризуется высокой частотой коморбидности, повышенным риском гипогликемий и необходимостью индивидуализации целей лечения. В этих условиях особую значимость приобретает выбор сахароснижающей терапии с благоприятным профилем безопасности. Цель настоящей работы – систематический анализ современных данных об эффективности и безопасности вилдаглиптина у пациентов в возрасте 65 лет и старше с СД 2. Обзор выполнен в соответствии с рекомендациями PRISMA 2020 с использованием модели PICOS. Поиск литературы проводился в базах PubMed, MEDLINE, Cochrane Library и eLibrary за период 2020–2026 гг. В итоговый анализ включены 10 клинических исследований и метаанализов, посвященных применению вилдаглиптина у пожилых пациентов как в виде монотерапии, так и в составе комбинированных схем лечения. Анализ показал, что вилдаглиптин обеспечивает клинически значимое снижение гликированного гемоглобина (в среднем на 0,7–1,2%), уменьшает постпрандиальную гипергликемию на 2–3 ммоль/л и снижает вариабельность гликемии. Препарат характеризуется низким риском гипогликемий (менее 1%), нейтральным влиянием на массу тела и благоприятным профилем переносимости: частота нежелательных явлений не превышает 5%, преимущественно в виде легких симптомов. В реальной клинической практике до 68–70% пожилых пациентов достигают целевых значений гликированного гемоглобина при применении вилдаглиптина в составе комбинированной терапии. Отдельное значение имеет возможность применения препарата у пациентов с сопутствующими сердечно-сосудистыми заболеваниями и хронической болезнью почек, а также его низкий потенциал лекарственных взаимодействий, что особенно важно в условиях полипрагмазии. Дополнительно обсуждаются потенциальные кардио-, нефро- и нейропротективные эффекты вилдаглиптина. Таким образом, вилдаглиптин в дозе 50–100 мг/сут представляет собой эффективный и безопасный вариант для оптимизации сахароснижающей терапии у пожилых пациентов с СД 2, особенно при высоком риске гипогликемий и наличии коморбидной патологии. Его применение может рассматриваться как рациональный компонент персонализированной сахароснижающей терапии в гериатрической практике.

Ключевые слова: сахарный диабет 2-го типа, вилдаглиптин, ингибиторы дипептидилпептидазы 4-го типа, пожилые, коморбидность

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Type 2 diabetes mellitus (T2DM) is highly prevalent among older adults and is characterized by a high burden of comorbidity, an increased risk of hypoglycemia, and the need for individualized treatment targets. In this context, the choice of glucose-lowering therapy with a favorable safety profile is of particular importance. The aim of this study was to conduct a systematic analysis of current evidence regarding the efficacy and safety of vildagliptin in patients aged 65 years and older with T2DM. This review was performed in accordance with the PRISMA 2020 guidelines using the PICOS framework. A literature search was conducted in the PubMed, MEDLINE, Cochrane Library, and eLibrary databases covering the period from 2020 to 2026. A total of 10 clinical studies and meta-analyses evaluating the use of vildagliptin in older patients, either as monotherapy or as part of combination regimens, were included in the final analysis. The analysis demonstrated that vildagliptin provides a clinically significant reduction in HbA1c (mean reduction of 0.7–1.2%), reduces postprandial hyperglycemia by 2–3 mmol/L, and decreases glycemic variability. The drug is characterized by a low risk of hypoglycemia (less than 1%), a neutral effect on body weight, and a favorable tolerability profile, with an adverse event rate not exceeding 5%, predominantly consisting of mild symptoms. In real-world clinical practice, 68–70% of older patients achieve target HbA1c levels when treated with vildagliptin as part of combination therapy. Of particular importance is the drug’s suitability for patients with concomitant cardiovascular disease and chronic kidney disease, as well as its low potential for drug-drug interactions, which is especially critical in the context of polypharmacy. Potential cardio-, nephro-, and neuroprotective effects of vildagliptin are also discussed. Thus, vildagliptin at a dose of 50–100 mg/day represents an effective and safe option for optimizing glucose-lowering therapy in older patients with T2DM, particularly in those at high risk of hypoglycemia and with comorbid conditions. Its use may be considered a rational component of personalized glucose-lowering therapy in geriatric practice.

Keywords: diabetes mellitus type 2, vildagliptin, dipeptidyl peptidase type IV inhibitors, aged, comorbidity

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1. Magliano DJ, Boyko EJ, IDF Diabetes Atlas 10th edition scientific committee. IDF DIABETES ATLAS. 10th ed. Brussels: International Diabetes Federation, 2021. Available at: http://www.ncbi.nlm.nih.gov/books/NBK581934/ Accessed: 04.02.2026.
2. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203-34. DOI:10.1016/S0140-6736(23)01301-6
3. American Diabetes Association Professional Practice Committee. 13. Older Adults: Standards of Care in Diabetes – 2025. Diabetes Care. 2024;48(1 Suppl. 1):S266-82. DOI:10.2337/dc25-S013
4. Dedov II, Shestakova MV, Vikulova OK, et al. Sakharnyi diabet v Rossiiskoi Federatsii: dinamika kliniko-epidemiologicheskikh pokazatelei bazy dannykh sakharnogo diabeta za period 2010–2024 gg. In: Sbornik tezisov X (XXXI) Natsionalnogo diabetologicheskogo kongressa s mezhdunarodnym uchastiem „Sakharnyi diabet – neinfektsionnaia pandemiia XXI veka. Makro- i mikrososudistye oslozhneniia. Voprosy mezhdistsiplinarnogo vzaimodeistviia“ (NDK 2025). Moscow: OOO Tipografiia „Pechatnykh Del Master“, 2025 (in Russian). DOI:10.14341/Cong27-30.05.25-33-34
5. Shestakova MV, Vikulova OK, Zheleznyakova AV, et al. Diabetes mellitus in the elderly: clinical and epidemiological characteristics of the all-Russian cohort of diabetic patients over 65 years. Diabetes Mellitus. 2024;27(6):504-19 (in Russian). DOI:10.14341/DM13261
6. Yu X, Kan C, Zhang K, et al. Global epidemiology and burden of type 2 diabetes in adults aged 55 and older: insights from 1990 to 2021. Ther Adv Endocrinol Metab. 2025;16:20420188251362011. DOI:10.1177/20420188251362011
7. Hashemi R, Rabizadeh S, Yadegar A, et al. High prevalence of comorbidities in older adult patients with type 2 diabetes: a cross-sectional survey. BMC Geriatr. 2024;24(1):873. DOI:10.1186/s12877-024-05483-3
8. Standards of specialized diabetes care. Ed. II Dedov, MV Shestakova, OYu Sukhareva. 12th ed. Available at: https://endoinfo.ru/upload/iblock/f46/vim4elq45pp3r07l8ooep550qiknatul/ALG_CD_20250503_250513_073615...: Accessed: 04.02.2026 (in Russian).
9. Dedov II, Shestakova MV, Vikulova OK, et al. Epidemiology and key clinical and therapeutic indicators of diabetes mellitus in Russian Federation according to the world health organization's strategy goals. Diabetes Mellitus. 2025;28(1):4-17 (in Russian). DOI:10.14341/DM13292
10. Pervyshin NA. Clinical and Laboratory Characteristics of Elderly Patients with Type 2 Diabetes Mellitus in Samara, Russia: A Registry-Based Study. Russ Open Med J. 2025;14(3):e0314. DOI:10.15275/rusomj.2025.0314
11. Drake T, Landsteiner A, Langsetmo L, et al. Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Systematic Review and Network Meta-analysis for the American College of Physicians. Ann Intern Med. 2024;177(5):618-32. DOI:10.7326/M23-1490
12. Selvaraj V. Efficacy and Safety of Vildagliptin Versus Other Dipeptidyl Peptidase 4 (DPP-4) Inhibitors in the Management of Type 2 Diabetes Mellitus: A Systematic Review of Randomized Controlled Trials. Cureus. 2025;17(9):e91432. DOI:10.7759/cureus.91432
13. Bekiari E, Rizava C, Athanasiadou E, et al. Systematic review and meta-analysis of vildagliptin for treatment of type 2 diabetes. Endocrine. 2016;52(3):458-80. DOI:10.1007/s12020-015-0841-1
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15. Halimi S, Raccah D, Schweizer A, Dejager S. Role of vildagliptin in managing type 2 diabetes mellitus in the elderly. Curr Med Res Opin. 2010;26(7):1647-56. DOI:10.1185/03007995.2010.485881
16. Keating GM. Vildagliptin: a review of its use in type 2 diabetes mellitus. Drugs. 2014;74(5):587-610. DOI:10.1007/s40265-014-0199-3
17. Pratley RE, Rosenstock J, Pi-Sunyer FX, et al. Management of type 2 diabetes in treatment-naive elderly patients: benefits and risks of vildagliptin monotherapy. Diabetes Care. 2007;30(12):3017-22. DOI:10.2337/dc07-1188
18. Schweizer A, Dejager S, Foley JE, et al. Clinical experience with vildagliptin in the management of type 2 diabetes in a patient population ≥75 years: a pooled analysis from a database of clinical trials. Diabetes Obes Metab. 2011;13(1):55-64. DOI:10.1111/j.1463-1326.2010.01325.x
19. Stein SA, Lamos EM, Davis SN. Vildagliptin, a dipeptidyl peptidase-4 inhibitor, for the treatment of type 2 diabetes. Expert Opin Drug Metab Toxicol. 2014;10(4):599-608. DOI:10.1517/17425255.2014.889683
20. Ding Y, Liu Y, Qu Y, et al. Efficacy and safety of combination therapy with vildagliptin and metformin vs. metformin monotherapy for Type 2 Diabetes Mellitus therapy: a meta-analysis. Eur Rev Med Pharmacol Sci. 2022;26(8):2802-17. DOI:10.26355/eurrev_202204_2861
21. Ametov AS, Petunina NA, Karonova TL, Martirosian NS. Efficacy and safety of vildagliptine and metformin in patients with newly diagnosed type 2 diabetes: results of the observational program „VIL-DA! “ Endocrinology: News, Opinions, Training. 2025;14(1):7-17 (in Russian). DOI:10.33029/2304-9529-2025-14-1-07-17
22. Kong D, Shen Z, Jiang L, et al. The effects of vildagliptin on glycemic variability in patients with type 2 diabetes on premixed insulin therapy. Front Endocrinol (Lausanne). 2025;16:1508918. DOI:10.3389/fendo.2025.1508918
23. Xiaoyan C, Jing W, Xiaochun H, et al. Effects of vildagliptin versus saxagliptin on daily acute glucose fluctuations in Chinese patients with T2DM inadequately controlled with a combination of metformin and sulfonylurea. Curr Med Res Opin. 2016;32(6):1131-6. DOI:10.1185/03007995.2016.1162773
24. Tanaka K, Okada Y, Mori H, et al. Comparative analysis of the effects of alogliptin and vildagliptin on glucose metabolism in type 2 diabetes mellitus. Endocr J. 2017;64(2):179-89. DOI:10.1507/endocrj.EJ16-0341
25. Koyanagawa N, Miyoshi H, Ono K, et al. Comparative effects of vildagliptin and sitagliptin determined by continuous glucose monitoring in patients with type 2 diabetes mellitus. Endocr J. 2016;63(8):747-53. DOI:10.1507/endocrj.EJ16-0266
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Авторы

В.А. Васильева*, Л.А. Марченкова

ФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Минздрава России, Москва, Российская Федерация
*valeri08.00@bk.ru

________________________________________________

Valeriia A. Vasileva*, Larisa A. Marchenkova

National Medical Research Center for Rehabilitation and Balneology, Moscow, Russian Federation
*valeri08.00@bk.ru

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