Comparison of Glucose Lowering Effect of Metformin and Acarbose in Type 2 Diabetes Mellitus: A Meta-Analysis

Abstract

BackgroundMetformin is the first-line oral hypoglycemic agent for type 2 diabetes mellitus recommended by international guidelines. However, little information exists comparing it with acarbose which is also commonly used in China. This study expanded knowledge by combining direct and indirect evidence to ascertain the glucose lowering effects of both drugs.MethodsPubMed (1980- December 2013) and China National Knowledge Infrastructure databases (1994-January 2014) were systematically searched for eligible randomized controlled trials from Chinese and English literatures. Meta-analysis was conducted to estimate the glucose lowering effects of metformin vs. acarbose, or either of them vs. common comparators (placebo or sulphonylureas), using random- and fixed-effect models. Bucher method with indirect treatment comparison calculator was applied to convert the summary estimates from the meta-analyses into weighted-mean-difference (WMD) and 95% confidence intervals (CIs) to represent the comparative efficacy between metformin and acarbose.ResultsA total of 75 studies were included in the analysis. In direct comparison (8 trials), metformin reduced glycosylated hemoglobin (HbA1c) by 0.06% more than acarbose, with no significant difference (WMD,-0.06%; 95% CI, -0.32% to 0.20%). In indirect comparisons (67 trials), by using placebo and sulphonylureas as common comparators, metformin achieved significant HbA1c reduction than acarbose, by -0.38% (WMD,-0.38%, 95% CI, -0.736% to -0.024%) and -0.34% (WMD, -0.34%, 95% CI, -0.651% to -0.029%) respectively.ConclusionThe glucose lowering effects of metformin monotherapy and acarbose monotherapy are the same by direct comparison, while metformin is a little better by indirect comparison. This implies that the effect of metformin is at least as good as acarbose's.

Acarbose Protects From Central and Peripheral Metabolic Imbalance Induced by Benzene Exposure

“…ACA has been used clinically to prevent postprandial hyperglycemia for many years, and has been used to treat patients with T2DM or glucose intolerance [35]. Similarly to metformin, ACA has beneficial effects on body weight, onset of diabetes and cardiovascular risk [36,37]. In mice, ACA effect replicates some aspects of diet or caloric restriction associated with increased lifespan [38][39][40][41], and with inhibition of age-associated hypothalamic inflammation in a sex-specific manner [42].…”

Fractionation and α-glucosidase Inhibitory Activity of Fractions from Garcinia hombroniana Pierre Leaves Extracts

“…The α-glucosidase inhibitor is responsible for the degradation of carbohydrates, it slows down the degradation of carbohydrates by inhibiting the activity of α-glucosidase competitively, so postprandial blood glucose level can be decreased and the postprandial blood glucose level comes under control. α-glucosidase inhibitors can be an alternative first line agent and provide several benefits, 3 it has been recommended by American Association of Clinical Endocrinologists and Third Asia-Pacific Region Diabetes Treatment Guidelines as the first-line of treatment for lowering postprandial hyperglycemia. Their efficacy in lowering HbA1c, and reducing post-meal blood sugars, make them suitable for use in type 2 diabetes.…”

Efficacy and safety of Dapagliflozin vs. Canagliflozin in addition to metformin for treatment of type 2 diabetes, a randomized, double-blind, non-inferiority clinical trial

“…Reduction of at least 0.5% is recommended for treating T2DM (15). Various studies on both dapagliflozin and canagliflozin have shown a reduction of Hba1c of 0.8% when compared to both placebos and active comparators (16,17,18,19,20).…”