Acarbose With Comparable Glucose-Lowering but Superior Weight-Loss Efficacy to Dipeptidyl Peptidase-4 Inhibitors: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Acarbose and dipeptidyl peptidase-4 inhibitors (DPP-4is) have several similarities regarding their efficacy. Assessing the hypoglycemic and weight-loss effects, as well as the tolerability between them at their optimal dosages, could provide a better management of adult type 2 diabetics.Methods: We performed a systematic review and network meta-analysis (NMA) on randomized controlled trials that were identified from the databases of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Conference Proceedings Citation Index, ClinicalTrials.gov, China National Knowledge Infrastructure, Wan Fang, and SinoMed. The trials with 300 mg/day of acarbose or the recommended doses of DPP-4is were the most optimal for our NMA. The mean differences (MD) and relative risk (RR) derived from eligible studies were used.Results: Among the 15,411 obtained potential studies, 13 pair-wise trials and 48 monotherapy studies were included in the meta-analysis and NMA, respectively. DPP-4is had a greater glucose-lowering effect, but a weaker weight-loss effect than acarbose in pair-wise meta-analysis (p < 0.05). However, NMA with 11,877 participants showed that, at their optimal doses, acarbose and DPP-4is had similar glucose-lowering effects on the 2-h postprandial glucose (MD 0.96 mmol/L, 95% credible interval −0.56 to 2.54), HbA1c (0.05%, −0.25 to 0.33), fasting plasma glucose reductions (−0.27 mmol/L, −0.76 to 0.24), and HbA1c < 7.0% target goal achievement (RR 1.33, 0.51 to 3.64). Acarbose was superior to DPP-4is regarding weight loss (MD −1.23 kg, −2.08 to −0.33). Acarbose had more withdrawal, gastrointestinal, and overall adverse events than DPP-4is (p < 0.05), but the differences disappeared after longer treatment (p > 0.05).Conclusions: Acarbose and DPP-4is have similar glucose-lowering effects, but the weight-loss effects of acarbose are superior. Therefore, in the use of the most optimal dosages, overweight/obese type 2 diabetics might benefit more from a treatment with acarbose than DPP-4is.

Glucose Deprivation Induced by Acarbose and Oncolytic Newcastle Disease Virus Promote Metabolic Oxidative Stress and Cell Death in a Breast Cancer Model

“…Moreover, ACA (glucose deprivation inducer) reduced relative body weight compared with the control group. ACA inhibits alpha-amylase and alpha-glucosidase; therefore, delayed absorption of complex carbohydrates from the intestine leads to decreased glucose level and body weight (Zhang et al, 2020).…”

Medical Management of Obesity as it Affects Reflux

“…61 Acarbose inhibits alpha glucosidases at the intestinal brush border, thereby slowing or preventing conversion of disaccharides and polysaccharides into monosaccharides, and is associated with very modest weight loss without alterations in energy intake in patients with diabetes. 62,63 Acarbose also has a role in the management of dumping syndrome after bariatric or foregut surgery. 64,65 The most common adverse effects include abdominal pain, bloating, flatulence, and diarrhea, which likely result from increased colonic fermentation of carbohydrates.…”

Diabetes: how to manage overweight and obesity in type 2 diabetes mellitus

“… 70 A median weight reduction of 3.5 kg was achieved when acarbose 100 mg three times daily was added to a sulfonylurea in a group of patients with T2DM. 71 When weight loss efficacy was compared between acarbose and DPP-IV inhibitors in a meta-analysis of randomized controlled trials, acarbose demonstrated superiority ( p <0.05). There was a mean difference of −1.23 kg favouring acarbose.…”