Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial

Chiasson, Jean‐Louis; Josse, Robert G.; Gomis, Ramón; Hanefeld, Markolf; Karasik, Avraham; Laakso, Markku

doi:10.1016/s0140-6736(02)08905-5

Cited by 2,325 publications

(1,495 citation statements)

References 22 publications

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“…The diabetes prevention studies included individuals with elevated fasting and post-load glucose concentrations who were already at the brink of diabetes [10][11][12][13]. Therefore, minimal differences in fasting plasma glucose of 0.3 mmol/l or HbA 1c values of 0.1% may relate to pronounced differences in the proportions of persons with a diagnosis of diabetes of 15% and diabetes risk reductions of more than 50% [16].…”

Section: Discussionmentioning

confidence: 99%

“…The Finnish Diabetes Prevention Study included HbA 1c as a secondary outcome measure [21] but did not report results in the main publication [10]. Neither blood glucose nor HbA 1c values were reported in the core publication of the STOP-NIDDM Acarbose prevention study [13]. A recent systematic analysis by Chan and Altman has found that incomplete reporting of outcomes within published articles of randomised trials is common and is associated with statistical non-significance [22].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several randomised controlled trials on the primary prevention of diabetes have been published [10][11][12][13]. Since then a reduction of diabetes by more than 50% has been publicly claimed and large-scale population interventions are being promoted [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Understanding of diabetes prevention studies: questionnaire survey of professionals in diabetes care

2006

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Aims/hypothesis: Diabetes prevention studies have reported reductions of diabetes risk by up to 60%. Since the underlying metabolic changes are small, the clinical significance of this effect may be overestimated. The present survey explores the extent to which different formats of presenting study results may influence diabetes healthcare professionals' perceptions of the importance of intervention effects on diabetes risk. Subjects, materials and methods: Participants of three European diabetes conferences (160 nurse educators, 112 physicians, 27 other professionals) were presented with a questionnaire that included nine items, in which results from three diabetes prevention studies were presented in different ways. Results: Participation rate was 96%. Effects were interpreted as important or very important by 92% (255/276) when results were presented as proportions of subjects with diabetes (14% intervention group, 29% control group), by 87% (248/285) when results were communicated as a risk reduction of 57%, by 39% (110/284) when the corresponding fasting plasma glucose values were presented (mean difference 0.3 mmol/l), and by 18% (52/283) when glycosylated haemoglobin values were used (6.0 vs 6.1%). Corresponding results of the three diabetes prevention studies were rated as being of identical importance by only 23, 13 and 16% of participants, respectively. Conclusions and interpretation: Healthcare professionals rate the benefit of preventive interventions substantially higher when changes in diabetes risk are communicated rather than related glycaemic parameters. Transformation of continuous metabolic data into diagnostic categories may impair understanding of study effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Understanding of diabetes prevention studies: questionnaire survey of professionals in diabetes care

2006

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“…Interventions that might reduce the conversion from IGT to diabetes mellitus and reduce the associated rates of death and complications from cardiovascular causes are highly desirable. Several trials have shown that lifestyle modification5 and pharmacological therapy, including metformin,6 acarbose,7 and rosiglitazone,8 reduce the incidence of diabetes mellitus. Examination of regional registries suggests differences in the conversion from IGT to diabetes mellitus,9, 10, 11 yet variable methodology, length of follow‐up, and differences in collected data limit comparisons between regions.…”

Section: Introductionmentioning

confidence: 99%

International Variation in Outcomes Among People with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial

Santos

Sharma

Sun

et al. 2017

JAHA

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BackgroundRegional differences in risk of diabetes mellitus and cardiovascular outcomes in people with impaired glucose tolerance are poorly characterized. Our objective was to evaluate regional variation in risk of new‐onset diabetes mellitus, cardiovascular outcomes, and treatment effects in participants from the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial.Methods and Results NAVIGATOR randomized people with impaired glucose tolerance and cardiovascular risk factors or with established cardiovascular disease to valsartan (or placebo) and to nateglinide (or placebo) with a median 5‐year follow‐up. Data from the 9306 participants were categorized by 5 regions: Asia (n=552); Europe (n=4909); Latin America (n=1406); North America (n=2146); and Australia, New Zealand, and South Africa (n=293). Analyzed outcomes included new‐onset diabetes mellitus; cardiovascular death; a composite cardiovascular outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; and treatment effects of valsartan and nateglinide. Respective unadjusted 5‐year risks for new‐onset diabetes mellitus, cardiovascular death, and the composite cardiovascular outcome were 33%, 0.4%, and 4% for Asia; 34%, 2%, and 6% for Europe; 37%, 4%, and 8% for Latin America; 38%, 2%, and 6% for North America; and 32%, 4%, and 8% for Australia, New Zealand, and South Africa. After adjustment, compared with North America, European participants had a lower risk of new‐onset diabetes mellitus (hazard ratio 0.86, 95% CI 0.78–0.94; P=0.001), whereas Latin American participants had a higher risk of cardiovascular death (hazard ratio 2.68, 95% CI 1.82–3.96; P<0.0001) and the composite cardiovascular outcome (hazard ratio 1.48, 95% CI 1.15–1.92; P=0.003). No differential interactions between treatment and geographic location were identified.ConclusionsMajor regional differences regarding the risk of new‐onset diabetes mellitus and cardiovascular outcomes in NAVIGATOR participants were identified. These differences should be taken into account when planning global trials.Clinical Trial RegistrationURL: http://www.ClinicalTrials.gov. Unique identifier: NCT00097786.

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“…Although active intervention for postprandial hyperglycemia by acarbose, an α‐glucosidase inhibitor (α‐GI), prevents development of cardiovascular events 1 , it is also important to flatten the postprandial glucose fluctuation to prevent macroangiopathy. α‐GI not only inhibits the rapid elevation of postprandial blood glucose level without excessive insulin secretion, but also enhances active glucagon‐like peptide‐1 (GLP‐1) secretion 2 .…”

Section: Introductionmentioning

confidence: 99%

Synergistic effect of α-glucosidase inhibitors and dipeptidyl peptidase 4 inhibitor treatment

Horikawa

Enya

Iizuka

et al. 2010

Journal of Diabetes Investigation

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Monotherapy of α‐glucosidase inhibitor (α‐GI) or dipeptidyl peptidase 4 (DPP4) inhibitor does not sufficiently minimize glucose fluctuations in the diabetic state. In the present study, we evaluated the combined effects of various of α‐GI inhibitors (acarbose, voglibose or miglitol) and sitagliptin, a DPP4 inhibitor, on blood glucose fluctuation, insulin and active glucagon‐like peptide‐1 (GLP‐1) levels after nutriment loading in mice. Miglitol and sitagliptin elicited a 47% reduction (P < 0.05) of the area under the curve of blood glucose levels for up to 2 h after maltose‐loading, a 60% reduction (P < 0.05) in the range of blood glucose fluctuation, and a 32% decrease in plasma insulin compared with the control group. All three of the combinations elicited a 2.5–4.9‐fold synergistic increase in active GLP‐1 (P < 0.05 vs control). Thus, combined treatment with the α‐GI miglitol, which more strongly inhibits the early phase of postprandial hyperglycemia, and DPP4 inhibitor yields both complementary and synergistic effects, and might represent a superior anti‐hyperglycemic therapy. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00081.x, 2011)

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Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial

Cited by 2,325 publications

References 22 publications

Understanding of diabetes prevention studies: questionnaire survey of professionals in diabetes care

Understanding of diabetes prevention studies: questionnaire survey of professionals in diabetes care

International Variation in Outcomes Among People with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial

Synergistic effect of α-glucosidase inhibitors and dipeptidyl peptidase 4 inhibitor treatment

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