Effect of acarbose to delay progression of carotid intima–media thickness in early diabetes

Abstract

Background The antidiabetic agent acarbose reduces postprandial glucose excursions. We have evaluated the effect of randomized treatment with acarbose on the progression of carotid intima-media thickness (IMT) in early diabetes. Methods The Early Diabetes Intervention Program (EDIP) was a randomized trial of acarbose versus placebo, in 219 participants with early diabetes characterized by glucose values over 11.1 mmol/L 2 hours after a 75g oral glucose load, and mean HbA1c 6.3%. IMT was measured at baseline and yearly. Follow-up was discontinued if participants progressed to the study glucose endpoints; IMT readings were available for a median of 2 years, with 72 subjects followed for 5 years. Results Progressive increases in IMT were seen in both treatment groups, but this was reduced in participants randomized to acarbose (p=0.047). In age, sex and smoking-adjusted analyses IMT progression was associated with greater fasting and OGTT-excursion glucose, fasting insulin, cholesterol, and glycated LDL concentrations. IMT progression was reduced with study-related changes in weight, insulin, and nonesterified fatty acids; these features were more strongly associated with reduced IMT progression than acarbose treatment. Despite strong associations of baseline glycemia with IMT progression, study-related changes in glucose were not important determinants of IMT progression. Conclusions Acarbose can delay progression of carotid intima-media thickness in early diabetes defined by an oral glucose tolerance test. Glucose, weight, insulin and lipids contributed to risk of progression but reductions in glycemia were not major determinants of reduced rate of IMT progression. Vascular benefits of acarbose may be independent of its glycemic effects.

Change of carotid intima‐media thickness is associated with age in elderly Japanese patients without a history of cardiovascular disease

“…We speculate that the design of the present study and the characteristics of the participants could be responsible for this result. Previous studies have found that treatment for a single risk factor can delay CIMT progression . In contrast, the present participants were concurrently treated for several cardiovascular risk factors during the study period.…”

“…Also, the Tromsø Study found that traditional cardiovascular risk factors were more strongly related to carotid plaque area and carotid plaque progression than to CIMT thickness and CIMT progression . Many studies have shown that progression of CIMT can be prevented by treating risk factors . Hence, progression of CIMT might also be prevented by reducing intimal thickening .…”

Therapeutic potential of α-glucosidase inhibitors in type 2 diabetes mellitus: an evidence-based review

“…Furthermore, in patients with early diabetes followed-up for 5 years, acarbose therapy was found to delay the progression of carotid intima-media thickness (IMT) than placebo [146]. Beneficial effects of AGIs on carotid IMT have been previously reported in Asian [147,155] and Caucasian [151] cohorts.…”

“…In patients with T2DM, acarbose monotherapy can control inflammation, endothelial dysfunction and atherosclerosis by decreasing the activity of NFkB in the peripheral blood mononuclear cells through reduction of PPG peaks [144]. Studies that demonstrated CV benefits of AGIs are listed in Table 6 [145][146][147][148][149][150][151][152][153][154][155]. Endothelial dysfunction has been regarded as a possible causal link between PPHG and CV events in patients with T2DM [156].…”

Lipid Effects and Cardiovascular Disease Risk Associated with Glucose-Lowering Medications

“…Beneficial anti-inflammatory effects have also been attributed to this drug class. Indeed, acarbose has been shown to reduce PAI-1 and fibrinogen levels in diabetic patients [67] and to decrease atherosclerotic plaque progression [68,69]. In animal models of myocardial injury, voglibose improved left ventricular function by decreasing myocardial oxidative stress and reduced myocardial infarct size [70,71].…”