Can diabetes risk be cut in elderly by aspirin?

Sydney: Use of low-dose (100mg daily) aspirin among older adults aged 65 years and older is associated with a 15 per cent lower risk of developing Type 2 diabetes, according to a study.

The effect of aspirin on incident type 2 diabetes among older adults remains uncertain.

In the study, researchers at Monash University in Australia investigated the randomised treatment effect of low-dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels among older adults.

"Aspirin treatment reduced incident diabetes and slowed the increase in fasting plasma glucose over time among initially healthy older adults," said Professor Sophia Zoungas, School of Public Health and Preventive Medicine at Monash.

"Given the increasing prevalence of type 2 diabetes among older adults, the potential for anti-inflammatory agents like aspirin to prevent type 2 diabetes or improve glucose levels needs further study," she added.

The findings were a follow-up of a 2018 study that showed that aspirin conferred a 38 per cent increased risk of major haemorrhage in older adults without any reduction in incidence of cardiovascular disease.

The new study enrolled 16,209 community-dwelling individuals aged 65 years or over, and free of cardiovascular disease, independence-limiting physical disability and dementia.

Patients with diabetes at the start of the study were excluded.

Participants were randomised 1:1 to 100 mg daily aspirin or placebo (8,086 randomised to aspirin and 8,123 to placebo). Incident diabetes was defined as self-report of diabetes, commencement of glucose-lowering medication, and/or a fasting plasma glucose (FBP) level of 7.0 mmol/L or higher at annual follow-up visits.

Over a median follow-up of 4.7 years, 995 incident diabetes cases were recorded (aspirin: 459, placebo: 536).

Compared with placebo, the aspirin group had a 15 per cent reduction in incident diabetes and a slower rate of increase in FPG.

However, "the earlier published trial findings from 2018 showed aspirin did not prolong healthy independent living, but was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract. Major prescribing guidelines now recommend older adults take daily aspirin only when there is a medical reason to do so, such as after a heart attack", Professor Zoungas said.

"Although these new findings are of interest, they do not change the clinical advice about aspirin use in older people at this time," she said.

The research will be presented at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) to be held in Germany in October.