Alpha-glucosidase inhibitors for type 2 diabetes mellitus
- 20 April 2005
- journal article
- research article
- Published by Wiley in Cochrane Database of Systematic Reviews
- Vol. 2009 (1), CD003639
- https://doi.org/10.1002/14651858.cd003639.pub2
Abstract
Alpha‐glucosidase inhibitors such as acarbose or miglitol, have the potential to improve glycemic control in type 2 diabetes mellitus. The true value of these agents, especially in relation to diabetes related mortality and morbidity, has never been investigated in a systematic literature review and meta‐analysis. To assess the effects of alpha‐glucosidase inhibitors in patients with type 2 diabetes mellitus. We searched The Cochrane Library, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, reference lists of reviews on the topic of alpha‐glucosidase inhibitors and we contacted experts and manufacturers for additional trials. Randomised controlled trials of at least 12 weeks duration comparing alpha‐glucosidase inhibitor monotherapy in patients with type 2 diabetes with any other intervention and that included at least one of the following outcomes: mortality, morbidity, quality of life, glycemic control, lipids, insulin levels, body weight, adverse events. Two reviewers read all abstracts, assessed quality and extracted data independently. Discrepancies were resolved by consensus or by the judgement of a third reviewer. A statistician checked all extracted data entrance in the database. We attempted to contact all authors for data clarification. We included 41 trials (8130 participants), 30 investigated acarbose, seven miglitol, one trial voglibose and three trials compared different alpha‐glucosidase inhibitors. Study duration was 24 weeks in most cases and only two studies lasted amply longer than one year. We found only few data on mortality, morbidity and quality of life. Acarbose had a clear effect on glycemic control compared to placebo: glycated haemoglobin ‐0.8% (95% confidence interval ‐0.9 to ‐0.7), fasting blood glucose ‐1.1 mmol/L (95% confidence interval ‐1.4 to ‐0.9), post‐load blood glucose ‐2.3 mmol/L (95% confidence interval ‐2.7 to ‐1.9). The effect on glycated haemoglobin by acarbose was not dose‐dependent. We found a decreasing effect on post‐load insulin and no clinically relevant effects on lipids or body weight. Adverse effects were mostly of gastro‐intestinal origin and dose dependent. Compared to sulphonylurea, acarbose decreased fasting and post‐load insulin levels by ‐24.8 pmol/L (95% confidence interval ‐43.3 to ‐6.3) and ‐133.2 pmol/L (95% confidence interval ‐184.5 to ‐81.8) respectively and acarbose caused more adverse effects. It remains unclear whether alpha‐glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes. Conversely, they have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. These effects are less sure when alpha‐glucosidase inhibitors are used for a longer duration. Acarbose dosages higher than 50 mg TID offer no additional effect on glycated hemoglobin but more adverse effects instead. Compared to sulphonylurea, alpha‐glucosidase inhibitors lower fasting and post‐load insulin levels and have an inferior profile regarding glycemic control and adverse effects.Keywords
This publication has 59 references indexed in Scilit:
- Miglitol, an α-glucosidase inhibitor, prevents the metformin-induced fall in serum folate and vitamin B12 in subjects with type 2 diabetesNutrition Research, 2000
- Acarbose Maintains Glycaemic Control in Diet Treated Type 2 DiabetesClinical Science, 1999
- An Asian Multicenter Clinical Trial to Assess the Efficacy and Tolerability of Acarbose Compared With Placebo in Type 2 Diabetic Patients Previously Treated With DietDiabetes Care, 1998
- Small weight loss on long-term acarbose therapy with no change in dietary pattern or nutrient intake of individuals with non-insulin-dependent diabetesInternational Journal of Obesity, 1997
- Acarbose for the treatment of Type II diabetes: the results of a Canadian multi-centre trialDiabetes Research and Clinical Practice, 1995
- Reduction of Glycosylated Hemoglobin and Postprandial Hyperglycemia by Acarbose in Patients With NIDDM: A placebo-controlled dose-comparison studyDiabetes Care, 1995
- Multicenter, placebo-controlled trial comparing acarbose (BAY g 5421) with placebo, tolbutamide, and tolbutamide-plus-acarbose in non-insulin-dependent diabetes mellitusAmerican Journal Of Medicine, 1995
- The Efficacy of Acarbose in the Treatment of Patients with Non–Insulin-Dependent Diabetes Mellitus: A Multicenter, Controlled Clinical TrialAnnals of Internal Medicine, 1994
- Therapeutic Potentials of Acarbose as First-Line Drug in NIDDM Insufficiently Treated With Diet AloneDiabetes Care, 1991
- Effectiveness of acarbose, an alpha-glucosidase inhibitor, in uncontrolled non-obese non-insulin dependent diabetesEuropean Journal of Clinical Pharmacology, 1988