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Table 6 Recommendation for DPP-4 inhibitors in older people with type 2 diabetes

From: Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing

Recommendation Strength of the recommendation Quality of the evidence
The patient is taking DPP-4 inhibitors and HbA1c is <8.5% (70 mmol/mol). Please reconsider the use of gliptins for the management of type 2 diabetes in older adults because of scarce data on clinically relevant benefits of their use. Please take the patient’s symptoms into consideration. Weak
Reason: No trial data supporting long-term clinically-relevant benefits in older people. One RCT pointing at possible adverse long-term effects independently from age.
The evidence was graded low quality. It was considered to downgrade the quality of the evidence to low quality because there were study limitations (1 observational study and a pooled analysis), indirectness (most of the studies did not report data in older people, apart from the pooled analysis), inconsistency (different types of DPP-4 inhibitors evaluated), and lack of data of long-term benefits under DPP-4 inhibitors in older people.