Efficacy and Safety of Acarbose in Metformin-Treated Patients With Type 2 Diabetes

Rosenstock, Julio; Brown, Alexandrea; Fischer, Jerome S.; Jain, A.; Littlejohn, Thomas; Nadeau, Daniel A.; Sussman, A.; Taylor, Terry; Krol, Alice; Magner, J.

doi:10.2337/diacare.21.12.2050

Cited by 95 publications

(58 citation statements)

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“…However, gastrointestinal side effects, including bloating, abdominal discomfort, diarrhoea and flatulence, which occur in up to 30% of patients treated with acarbose, frequently result in discontinuation of therapy. In one study, 56% of patients treated with acarbose plus metformin experienced gastrointestinal side effects and 12% discontinued therapy [22]. Recently, a second-generation α-glucosidase inhibitor, miglitol, has been shown to have similar effects when combined with metformin [27], although the results are less impressive than those seen with a combination of metformin with insulin secretion enhancers.…”

Section: Combination Regimens Currently In Usementioning

confidence: 85%

“…Its complementary mode of action with acarbose led to their use as combination therapy. The addition of acarbose to the therapeutic regimen in patients inadequately controlled with metformin and diet lowered HbA 1c , fasting and postprandial glucose as well as plasma insulin concentrations [22]. However, gastrointestinal side effects, including bloating, abdominal discomfort, diarrhoea and flatulence, which occur in up to 30% of patients treated with acarbose, frequently result in discontinuation of therapy.…”

Section: Combination Regimens Currently In Usementioning

confidence: 99%

“…The use of an α-glucosidase inhibitor in combination with sulphonylureas, metformin or insulin also results in improved glycaemic control [21,22,23,24]. These agents inhibit the hydrolysis of complex carbohydrates in the gastrointestinal tract and thereby delay postprandial glucose absorption.…”

Section: Combination Regimens Currently In Usementioning

confidence: 99%

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Rationale and options for combination therapy in the treatment of Type 2 diabetes

Gaal

Leeuw

2003

Diabetologia

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Pharmacological therapy for Type 2 (non-insulin-dependent) diabetes mellitus aims at controlling hyperglycaemia to delay or prevent complications associated with the disease. Most patients with Type 2 diabetes present with both stimulated insulin deficiency and insulin resistance. In general, the former can manifest as postprandial hyperglycaemia and the latter as fasting hyperglycaemia, though a definitive association has not been established. Emerging data show a high failure rate of long-term monotherapy and establishes the significance of mealtime glycaemia and the role of postprandial glucose excursions in the development and progression of vascular complications. To overcome such failures of monotherapy and to address the different underlying defects of the pathology of Type 2 diabetes, a combined therapy of oral antidiabetic agents with complementary modes of action should be considered. Currently used oral antidiabetic agents such as sulphonylureas, biguanides (metformin) and the thiazolidinediones (rosiglitazone, pioglitazone) commonly target fasting hyperglycaemia and have limited additive effects on postprandial glycaemia. In contrast, α-glucosidase inhibitors can reduce postprandial hyperglycaemia but gastrointestinal side effects restrict their use. The development of new agents to control postprandial glucose excursions could be considered as an additional objective for the management of Type 2 diabetes. To this end new short-acting enhancers of insulin secretion such as repaglinide (benzoic acid derivative) and nateglinide (amino acid derivative) have been developed. The combination of such agents with other complementary modes of action, e.g. an insulin sensitizer, could target better major underlying defects of Type 2 diabetes and thereby provide a better approach for controlling the entire glycaemic risk. [Diabetologia (2003)

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Section: Combination Regimens Currently In Usementioning

confidence: 85%

Section: Combination Regimens Currently In Usementioning

confidence: 99%

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Rationale and options for combination therapy in the treatment of Type 2 diabetes

Gaal

Leeuw

2003

Diabetologia

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“…However, acarbose has common gastrointestinal adverse effects, including abdominal pain, diarrhea and bloating (16). With the increasing promotion of medicine combinations, various studies have provided gradually increasing evidence that acarbose combined with metformin treatment has a higher efficacy than monotherapy (17)(18)(19). It has also been indicated that combined medicines have higher efficacy with regard to HbA1c, FBG and 2HPG as well as insulin levels (19).…”

Section: Introductionmentioning

confidence: 99%

Metformin combined with acarbose vs. single medicine in the treatment of type 2 diabetes: A meta-analysis

Liu

Zhao

Sun

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present meta-analysis aimed to evaluate metformin combined with acarbose compared with monotherapy with either of the two drugs for type 2 diabetes (T2DM). Relevant trials were retrieved through searching PubMed, Embase, Cochrane library, China National Knowledge Infrastructure, Wanfang and Chongqing VIP information network databases. Heterogeneous and homogeneous data were statistically combined using a random-and fixed-effects model, respectively. For dichotomous and continuous data, the merged effect size was presented as the risk ratio (RR) and weighted mean differences (WMD), respectively, with 95% confidence interval (CI). All included studies were divided into subgroups. A Funnel plot was used to detect publication bias. Review Manager 5.2 software was applied to perform the statistical analyses. Meta-analysis revealed that compared with metformin monotherapy, combined therapy was significantly more efficacious regarding indexes including the total effective rate, fasting blood glucose (FBG), blood glucose levels at two post-prandial hours (2HPG) and hemoglobin A1C (HbA1c). Similarly, combined therapy showed advantages on indexes including FBG, 2HPG and HbA1c over acarbose therapy after 4 months of treatment. In conclusion, the findings of the present meta-analysis suggested that combined therapy of metformin and acarbose appears to be more efficacious than metformin or acarbose monotherapy.

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“…• an important manifestation in the early course of type 2 diabetes mellitus (T2DM) • a critical target for achieving glycemic control • a contributing factor in the pathogenesis of cardiovascular disease -Acarbose indirectly optimizes glucose metabolism during the day through adaptation of insulin secretion 2 • Numerous studies have shown beneficial effects of acarbose as a 1st-, 2nd-and 3rd-line treatment option, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] for which it is recommended by both the International Diabetes Federation (IDF) and American Association for Clinical Endocrinologists (AACE) 29,30 • However, prescribing of acarbose varies around the world due to a perception that efficacy is limited in some ethnic and regional groups • We therefore analyzed pooled data from acarbose post-marketing studies (PMS) and non-interventional studies (NIS) to examine whether differences between patients of European Caucasian and Asian ethnicity exist based on a large body of evidence…”

Section: Introductionmentioning

confidence: 99%

Efficacy of acarbose in different geographical regions of the world: analysis of a real-life database

Kalra¹,

Soegondo²,

Schnell³

et al. 2014

EJEA

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Efficacy and Safety of Acarbose in Metformin-Treated Patients With Type 2 Diabetes

Abstract: The results of this study demonstrate that the addition of acarbose to patients with type 2 diabetes who are inadequately controlled with metformin and diet is safe and generally well tolerated and that it significantly lowers HbA1c and fasting and postprandial glucose and insulin levels.

Cited by 95 publications

References 0 publications

Rationale and options for combination therapy in the treatment of Type 2 diabetes

Rationale and options for combination therapy in the treatment of Type 2 diabetes

Metformin combined with acarbose vs. single medicine in the treatment of type 2 diabetes: A meta-analysis

Efficacy of acarbose in different geographical regions of the world: analysis of a real-life database

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