Effects on Blood Pressure of the ??-Glucosidase Inhibitor Acarbose Compared with the Insulin Enhancer Glibenclamide in Patients with Hypertension and Type 2 Diabetes Mellitus

Rosenthal, J.; Mauersberger, H

doi:10.2165/00044011-200222100-00006

Cited by 31 publications

(16 citation statements)

References 13 publications

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“…The overall comparison of acarbose with sulfonylurea yielded a nonsignificant advantage for sulfonylurea with respect to overall GHb of 0.38% (data not shown; online appendix C). However, seven of the studies in the meta-analyses used unequal comparators, because they compared a fixed dose of acarbose with individually adjusted dosages of sulfonylurea (24, 30,35,44,47,49) or a usual dose of acarbose with a very low dose of glibenclamide (32). The results for the subgroup "acarbose 100 mg versus glibenclamide 3.5 mg" were not consistent with the other comparisons.…”

Section: Glycemic Controlmentioning

confidence: 94%

α-Glucosidase Inhibitors for Patients With Type 2 Diabetes

et al. 2005

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OBJECTIVE -To review the effects of monotherapy with ␣-glucosidase inhibitors (AGIs) for patients with type 2 diabetes, with respect to mortality, morbidity, glycemic control, insulin levels, plasma lipids, body weight, and side effects. RESEARCH DESIGN AND METHODS -We systematically searched the CochraneCentral register of Controlled Trials, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, and reference lists, and we contacted experts and manufacturers. Inclusion criteria were randomized controlled trials of at least 12 weeks' duration, AGI monotherapy compared with any intervention, and one of the following outcome measures: mortality, morbidity, GHb, blood glucose, lipids, insulin levels, body weight, or side effects. Two independent reviewers assessed all abstracts, extracted all data, and assessed quality. We contacted all authors for data clarification. Continuous data were expressed as weighted mean differences and analyzed with a random-effects model. Possible influences of study characteristics and quality were assessed in sensitivity and meta-regression analyses.RESULTS -Forty-one studies were included in the review (30 acarbose, 7 miglitol, 1 voglibose, and 3 combined), and heterogeneity was limited. We found no evidence for an effect on mortality or morbidity. Compared with placebo, AGIs had a beneficial effect on GHb (acarbose Ϫ0.77%; miglitol Ϫ0.68%), fasting and postload blood glucose and postload insulin. With acarbose dosages higher than 50 mg t.i.d., the effect on GHb was the same, but the occurrence of side effects increased. Acarbose decreased the BMI by 0.17 kg/m 2 (95% CI 0.08 -0.26). None of the AGIs had an effect on plasma lipids. Compared with sulfonylurea, AGIs seemed inferior with respect to glycemic control, but they reduced fasting and postload insulin levels. For comparisons with other agents, little data were available.CONCLUSIONS -We found no evidence for an effect on mortality or morbidity. AGIs have clear beneficial effects on glycemic control and postload insulin levels but not on plasma lipids. There is no need for dosages higher than 50 mg acarbose t.i.d. Diabetes Care 28:166 -175, 2005A lpha-glucosidase inhibitors (AGIs; acarbose, miglitol, voglibose) are widely used in the treatment of patients with type 2 diabetes. AGIs delay the absorption of carbohydrates from the small intestine and thus have a lowering effect on postprandial blood glucose and insulin levels.In modern medicine, the efficacy of an intervention should be investigated in well-designed randomized trials. Results from the trials should be collected in a high-quality systematic review, if possible with a meta-analysis. And finally, the evidence should have its repercussions on practice guidelines.How does this apply for AGIs? Recommendations on when to use AGIs and the evidence used for these recommendations appear to be different in various guidelines. For example, the guideline by the European Diabetes Policy Group (1) and a consensus statement by the American Diabetes Association (2)...

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Section: Glycemic Controlmentioning

confidence: 94%

α-Glucosidase Inhibitors for Patients With Type 2 Diabetes

et al. 2005

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“…Further evidence for this effect was seen in a study of obese patients with mild hypertension and type 2 diabetes, where acarbose therapy reduced mean 24-h systolic and diastolic blood pressures by 5.2 and 2.4 mm Hg, respectively [52]. As insulin is known to stimulate the sympathetic nervous system, it is postulated that the lower postprandial insulin levels seen following acarbose treatment might result in sympathetic downregulation [53].…”

Section: Potential Mechanisms Of Acarbose-related Cardiovascular Protmentioning

confidence: 96%

Cardiovascular benefits of acarbose in impaired glucose tolerance and type 2 diabetes

Zeymer

2006

International Journal of Cardiology

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“…A double-blind, randomized, placebo-controlled study in 44 patients with type 2 diabetes found that achievement of good glycemic control with acarbose was accompanied by significant reductions in diurnal systolic, diastolic, and mean blood-pressure values (p < 0.05) [34]. Similarly, a randomized 6-month study in obese patients with diabetes found that acarbose treatment reduced the mean 24-h systolic blood pressure by a mean of 5.2 mmHg, compared with only 1.6 mmHg with glibenclamide (p = 0.0001) [35].…”

Section: Synergistic Effects On Metabolic Syndromementioning

confidence: 95%