Recent research to be presented at this yr’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany (2-6 October) shows that use of low dose (100mg day by day) aspirin amongst older adults aged 65 years and older is related to a 15% lower risk of developing type 2 diabetes. The authors, led by Professor Sophia Zoungas, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, say the outcomes show that anti-inflammatory agents comparable to aspirin warrant further study within the prevention of diabetes.

The effect of aspirin on incident type 2 diabetes amongst older adults stays uncertain. This study investigated the randomised treatment effect of low dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels amongst older adults. The authors did a follow-up study of the ASPREE trial – a double-blind, placebo-controlled trial of aspirin, the principal results of which were published in NEJM in 2018. The unique study showed that aspirin conferred a 38% increased risk of major haemorrhage in older adults with none reduction in incidence of heart problems.

The study enrolled community-dwelling individuals aged 65 years or over, and freed from heart problems, independence-limiting physical disability and dementia. Participants were randomised 1:1 to 100 mg day by day aspirin or placebo. Incident diabetes was defined as self-report of diabetes, commencement of glucose lowering medication, and/or a fasting plasma glucose (FBP) level of seven.0 mmol/L or higher at annual follow-up visits. Patients with diabetes at first of the study were excluded. Computer and statistical modelling assessed the effect of aspirin on incident diabetes and FPG levels respectively.

A complete of 16,209 participants were included within the evaluation (8,086 randomised to aspirin and eight,123 to placebo). 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% reduction in incident diabetes and a slower rate of increase in FPG (difference in annual FPG change: -0.006 mmol/L).

The authors say: “Aspirin treatment reduced incident diabetes and slowed the rise in fasting plasma glucose over time amongst initially healthy older adults. Given the increasing prevalence of type 2 diabetes amongst older adults, the potential for anti-inflammatory agents like aspirin to stop type 2 diabetes or improve glucose levels needs further study.”

Nonetheless, Professor Zoungas adds: “The sooner published trial findings from ASPREE in 2018 showed aspirin didn’t delay healthy independent living, but was related to a significantly increased risk of bleeding, primarily within the gastrointestinal tract. Major prescribing guidelines now recommend older adults take day by day aspirin only when there may be a medical reason to accomplish that, comparable to after a heart attack.”

“Although these latest findings are of interest, they don’t change the clinical advice about aspirin use in older people right now.”