Consilium Medicum · May 31, 2026

Vildagliptin in elderly patients with type 2 diabetes: a balance of efficacy and safety. A review

By Vasileva VA, Marchenkova L

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.

doi.org/10.26442/20751753.2026.4.203658 Open access Interventions