Introduction
hyperglycemia, stroke, T2D, diabetic macrovascular complications
STROKE, DYSFUNCTION, HYPERGLYCEMIA, INSULIN RESISTANCE, EVENTS, TYPE 2 DIABETES
The frequency of type 2 diabetes (T2D) in older ages has been reported to be increasing annually in Japan. According to a recent report from the Japan Ministry of Health, Labor and WelfareIn terms of diabetic macrovascular complications, a Japanese randomized trial, J-EDIT, which was designed to evaluate the benefits of a multifactorial intervention (including HbA1c levels < 6.9% in the treatment goal) in older adults with T2D failed to show a significant risk reduction in cardiovascular events or stroke by intensive treatmentDipeptidyl peptidase IV (DPP4) inhibitors are oral anti-hyperglycemic agents that enhance insulin secretion in a glucose-dependent manner, and are notably different from sulfonylureasEspecially for Japanese patients with T2D who have persistent hyperglycemia despite treatment with lifestyle intervention, insulin secretagogues such as glinides or sulfonylureas have traditionally been selected as the initial anti-diabetic drug in the past decades because β-cell dysfunction, rather than insulin resistance, is the primary cause of hyperglycemia in these patientsIn the present study, we recruited moderately controlled Japanese T2D patients aged 65–80 years with ordinary physical activity, who had been already under diet and exercise interventions without or with oral anti-diabetic drugs excluding DPP4 inhibitors or GLP-1 receptor agonists. Then, the participants were randomly allocated into sitagliptin group who received sitagliptin as an initial or an additive anti-diabetic drug to current treatment regimens and control group who did not, to evaluate the efficacy and safety of sitagliptin treatment in older adults with T2D.