European study on dose-response relationship of acarbose as a first-line drug in non-insulin-dependent diabetes mellitus: efficacy and safety of low and high doses

Fischer, Sabine; Hanefeld, Markolf; Spengler, M.; Boehme, K.; Temelkova‐Kurktschiev, Theodora

doi:10.1007/s005920050098

Cited by 57 publications

(36 citation statements)

References 8 publications

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“…The research presented herein demonstrated that vinegar ingestion at mealtime reduced PPG by about 20% on average compared to the placebo treatments. This reduction is comparable to those noted in trials that assessed the effects of ␣ -glucosidase inhibitors in patients with impaired glucose tolerance [15] and T2D [16] .…”

Section: Discussionsupporting

confidence: 66%

Examination of the Antiglycemic Properties of Vinegar in Healthy Adults

Johnston¹,

Steplewska²,

Long³

et al. 2010

Ann Nutr Metab

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Background: Vinegar reduces postprandial glycemia (PPG) in healthy adults. This study investigated the vinegar dosage (10 vs. 20 g), timing (during mealtime vs. 5 h before meal) and application (acetic acid as vinegar vs. neutralized salt) for reducing PPG. Methods: Four randomized crossover trials were conducted in adults (n = 9–10/trial) with type 2 diabetes (1 trial) or without diabetes (3 trials). All trials followed the same protocol: a standardized meal the evening prior to testing, an overnight fast (>10 h) and 2-hour glucose testing following consumption of a bagel and juice test meal (3 trials) or dextrose solution (1 trial). For each trial, PPG was compared between treatments using area-under-the-curve calculations 120 min after the meal. Results: Two teaspoons of vinegar (∼10 g) effectively reduced PPG, and this effect was most pronounced when vinegar was ingested during mealtime as compared to 5 h before the meal. Vinegar did not alter PPG when ingested with monosaccharides, suggesting that the antiglycemic action of vinegar is related to the digestion of carbohydrates. Finally, sodium acetate did not alter PPG, indicating that acetate salts lack antiglycemic properties. Conclusions: The antiglycemic properties of vinegar are evident when small amounts of vinegar are ingested with meals composed of complex carbohydrates. In these situations, vinegar attenuated PPG by ∼20% compared to placebo.

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Section: Discussionsupporting

confidence: 66%

Examination of the Antiglycemic Properties of Vinegar in Healthy Adults

Johnston¹,

Steplewska²,

Long³

et al. 2010

Ann Nutr Metab

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“…After title and abstract screening, 178 were potentially eligible (including 159 potentially relevant RCTs and 19 potentially relevant observational studies19202122232425262728293031323334353637). Ultimately, 14 RCTs1314151617183839404142434445 involving 2881 patients, proved eligible, and no observational studies were included.…”

Section: Resultsmentioning

confidence: 99%

Alpha-glucosidase inhibitors and hepatotoxicity in type 2 diabetes: a systematic review and meta-analysis

Zhang

Chen

et al. 2016

Sci Rep

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Alpha-glucosidase inhibitors (AGIs) was reported to be associated with several rare adverse hepatic events, but with inconsistent results. We aimed to investigate the risk of hepatotoxicity associated with the use of AGIs in patients with type 2 diabetes mellitus (T2DM), and performed a systematic review and meta-analysis. Fourteen studies (n = 2881) were eligible, all of which were RCTs. Meta-analysis of data regarding elevation of more than 3-fold the upper limit of normal (ULN) of AST and ALT showed statistically significant differences between AGIs treatment versus control (OR 6.86, 95% CI 2.50 to 18.80; OR 6.48, 95% CI 2.40 to 17.49). Subgroup analyses of elevation of more than 1.8-fold ULN of AST and ALT by dose of AGIs showed differential effects on AST and ALT (AST: OR 0.38 vs 7.31, interaction P = 0.003; ALT: OR 0.32 vs 4.55, interaction p = 0.02). Meta-analysis showed that AGIs might increase the risk of hepatotoxicity, and higher dose appeared to be associated with higher risk of hepatotoxicity. However, the evidence is limited with surrogate measures (i.e. ALT and AST), and no clinically important adverse events were observed.Alpha-glucosidase inhibitors (AGIs) are commonly used oral hypoglycemic drugs, especially in the patient population from East Asia 1-3 . The guideline of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommended the use of AGIs as a potentially first-line agent or in combination with other antihyperglycemic drugs 4 . AGIs has proven similarly efficacious as other commonly used antidiabetes agents [5][6][7] . A recent large trial 1 showed that acarbose is similar to metformin in terms of efficacy, and supports a viable choice for initial therapy in patients with newly diagnosed type 2 diabetes. Additionally, AGIs do not increase body weight, rarely cause hypoglycemia; and have minimal drug-drug interactions 1,7,8 . Meanwhile, AGIs was reported to be associated with several rare adverse hepatic events 9-11 and increase liver enzyme levels [12][13][14][15][16][17][18] . The causal relationship, however, has not been established 9 , and the magnitude of effect on the increase of liver enzyme levels remains unclear. Because these issues are often treated as adverse effects issues, and the hepatic adverse events, if any, are usually rare, individual trials are not adequate to address these important clinical questions. A meta-analysis -in which multiple studies are pooled -may offer opportunity to detect a small but clinically important difference.Thus, we carried out a systematic review of randomized controlled trials and observational studies to assess the association between hepatotoxicity and AGIs. We hypothesized that hepatotoxicity would be more frequently manifested in AGIs as opposed to no use. Figure 1 showed the study selection process. We acquired 5,318 reports. After title and abstract screening, 178 were potentially eligible (including 159 potentially relevant RCTs and 19 potentially relevant observational studies [1...

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“…Higher reductions are generally seen in treatment-naïve patients and those with higher baseline glycemic values (9,11). Treatment with acarbose seems somewhat less effective with reductions in HbA 1c of 0.5 to 1% compared with placebo in previously untreated patients (12)(13)(14). Most of the oral antihyperglycemic agents can be combined with each other and insulin therapy with additive effects.…”

Section: Glucose-lowering Efficacy Of Antihyperglycemic Agentsmentioning

confidence: 99%

“…However, severe episodes that require intervention are relatively rare (0 to 1.3%). Metformin, thiazolidinediones, and ␣-glucosidase inhibitors do not usually cause hypoglycemia when used alone but can potentiate the hypoglycemic potency of insulin secretagogues (4,7,9,12,14). Repaglinide and nateglinide are particular in having a rapid onset and short duration of action and can be given at mealtimes.…”

Section: Hypoglycemiamentioning

confidence: 99%

Oral Antihyperglycemic Agents and Renal Disease

Yale

2005

Journal of the American Society of Nephrology

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The results of the Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study trials in type 1 and type 2 diabetes, respectively, have proved the importance of intensive glucose management in the prevention of microvascular complications (retinopathy, nephropathy, and neuropathy). Both trials showed encouraging trends for a decrease in macrovascular complications, and this is being pursued in new studies. These findings have led to more strict goals for glucose control. As glucose levels are aimed to be closer to the normal range, the risk for hypoglycemia also increases dramatically. The choice of the agent therefore is more influenced currently by the risk for hypoglycemia. There are presently four classes of oral antihyperglycemic agents. These agents differ greatly in terms of mechanisms of action, efficacy, side effect profiles, and cost. Except for Acarbose, all classes decrease the glycosylated hemoglobin by a similar magnitude: 1.0 to 1.5%. In chronic renal failure, the oral agents that can be used therefore include the insulin secretagogues repaglinide and nateglinide and the thiazolidinediones (rosiglitazone and pioglitazone) with caution. Insulin also can be used safely in renal failure.

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European study on dose-response relationship of acarbose as a first-line drug in non-insulin-dependent diabetes mellitus: efficacy and safety of low and high doses

Cited by 57 publications

References 8 publications

Examination of the Antiglycemic Properties of Vinegar in Healthy Adults

Examination of the Antiglycemic Properties of Vinegar in Healthy Adults

Alpha-glucosidase inhibitors and hepatotoxicity in type 2 diabetes: a systematic review and meta-analysis

Oral Antihyperglycemic Agents and Renal Disease

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