MARCH2: Comparative Assessment of Therapeutic Effects of Acarbose and Metformin in Newly Diagnosed Type 2 Diabetes Patients

Wang, Guang; Liu, Jia; Yang, Ning; Gao, Xia; Fan, Hui; Xu, Yuan; Yang, Wenying

doi:10.1371/journal.pone.0105698

Cited by 21 publications

(26 citation statements)

References 35 publications

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“…Interestingly, because the patients were on different doses of metformin treatment, we re-analyzed the data according to the dose regime. Since the maximal metformin dose was 2500 mg/day, we considered a cut-off of 1500 mg/day for the low and high doses; 1500 mg/day is the standard dose required in pharmacological studies evaluating a second drug in T2DM patients already treated with metformin [25]. Although the mean value of the nucleosome levels in the high metformin dose group of T2DM patients was lower than that of the low dose group, they were not statistically different (Fig 5A).…”

Section: Resultsmentioning

confidence: 99%

NETosis before and after Hyperglycemic Control in Type 2 Diabetes Mellitus Patients

et al. 2016

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Introduction and ObjectiveDiabetes is characterized by chronic inflammation, endothelial dysfunction, increased risk of infections and early cardiovascular disease. By releasing neutrophil extracellular traps (NETs), neutrophils kill bacteria and exert pro-inflammatory and pro-thrombotic activities. Increased NETosis has been found in cross-sectional studies including treated type 2 diabetes mellitus (T2DM) patients. In this study, we determined whether the ability of neutrophils to form NETs differs in diabetic patients pre- and post-hyperglycemic control versus healthy donors (HD), and the relationship between NETosis with pro-thrombotic, pro-inflammatory biomarkers and thrombotic clinical events.MethodsDiabetic patients recently diagnosed and after 6 and 12 months of treatment (N = 25) and HD (N = 25) were included. NET formation was studied by microscopy and fluorometry. Nucleosomes, HNE-DNA complexes, von Willebrand factor (vWF), IL6 and TNFα plasma levels were measured by ELISA and P-selectin on the platelet surface was assessed by cytometry.ResultsBasal levels of NETs in recently diagnosed T2DM patients were higher compared to HD. While TNFα stimulation of control neutrophils resulted in DNA release, patient neutrophils were not responsive. Although glycemia decreased after 6 months of metformin treatment, basal and TNFα and PMA-stimulated NETs reached normal values after 12 months. Compared to controls, nucleosomes, HNE-DNA complexes, IL-6 and TNFα levels were increased in recently diagnosed patients and decreased after 12 months of treatment. P-selectin and vWF levels were similar in both populations.ConclusionOur data suggest that NETs could represent a biomarker for T2DM. Increased NETosis in T2DM patients does not appear to be the consequence of impaired glycemic control but rather due to pro-inflammatory cytokines and is not related to thrombotic events.

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Section: Resultsmentioning

confidence: 99%

NETosis before and after Hyperglycemic Control in Type 2 Diabetes Mellitus Patients

et al. 2016

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“…In metformin or AGI treated patients, the results from a prospective, multicenter, open-label study in newly diagnosed Chinese type 2 diabetes [7], indicated that baseline BMI had no impact on glycemic control, weight change or other efficacy measures. Another post-hoc analysis [14] of a randomized controlled trial also concluded that both acarbose and metformin similarly decreased the HbA1c levels regardless of the BMI status. In DPP-4 inhibitors treated patients, Schweizer reported a pooled-analysis [15] and the results indicated that it was efficaciously independent of the BMI group.…”

Section: Discussionmentioning

confidence: 99%

Baseline Body Mass Index and the Efficacy of Hypoglycemic Treatment in Type 2 Diabetes: A Meta-Analysis

et al. 2016

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AimThe aim of this study is to compare the effects of hypoglycemic treatments in groups of patients categorized according to the mean baseline body mass indexes (BMIs).MethodsStudies were identified by a literature search and all the studies were double blind, placebo-controlled randomized trials in type 2 diabetes patients; study length of ≥12 weeks with the efficacy evaluated by changes in HbA1c from baseline in groups. The electronic search was first conducted in January 2015 and repeated in June 2015.Results227 studies were included. Treatment with sulfonylureas was compared with placebo in overweight patients and resulted in a significantly greater change in the HbA1c levels (weighted mean difference (WMD), −1.39%) compared to obese patients (WMD, −0.77%)(p<0.05). Treatment with metformin in overweight patients resulted in a comparable change in the HbA1c levels (WMD, −0.99%) compared to obese patients (WMD, −1.06%)(p>0.05). Treatment with alpha glucosidase inhibitors in normal weight patients was associated with a HbA1c change (WMD, −0.94%) that was comparable that in overweight (WMD, −0.72%) and obese patients (WMD, −0.56%)(p>0.05). Treatment with thiazolidinediones in normal weight patients was associated with a HbA1c change (WMD, −1.04%) that was comparable with that in overweight (WMD, −1.02%) and obese patients (WMD, −0.88%)(p>0.05). Treatment with DPP-4 inhibitors in normal weight patients was associated with a HbA1c change (WMD, −0.93%) that was comparable with that in overweight (WMD, −0.66%) and obese patients (WMD, −0.61%)(p>0.05). In total, of the seven hypoglycemic agents, regression analysis indicated that the mean baseline BMI was not associated with the mean HbA1c changes from baseline.ConclusionIn each kind of hypoglycemic therapy in type 2 diabetes, the baseline BMI was not associated with the efficacy of HbA1c changes from baseline.

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“…Details of the study design, investigative centers, and patient inclusion/exclusion criteria for the MARCH study have been reported previously 11,12 . The patients had either not taken antidiabetic medication previously or had received only short-term (1 month) treatment that had been discontinued for 3 months prior to enrollment in the study.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…The effects of both drugs in reducing HbA1c were similar regardless of the patients' body mass index (BMI) 12 . Because certain populations may respond more favorably to either acarbose 13 or metformin, the present post-hoc analysis was undertaken to identify the characteristics of participants in the MARCH trial at baseline and in the treatment period that may be associated with greater efficacy in achieving a HbA1c level <7% (<53 mmol/mol).…”

Section: Introductionmentioning

confidence: 99%

Factors that influence the efficacy of acarbose and metformin as initial therapy in Chinese patients with newly diagnosed type 2 diabetes: a subanalysis of the MARCH trial

Zhang

Wang

Yang

et al. 2016

Current Medical Research and Opinion

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Newly diagnosed type 2 diabetes patients with lower baseline 2hPPG and HOMA-IR values are more likely to achieve glucose control with acarbose or metformin treatment. Furthermore, the change in BMI after acarbose or metformin treatment is also a factor influencing HbA1c normalization. A prospective study with a larger sample size is necessary to confirm our results as well as measure β cell function and examine the influence of the patients' dietary habits.

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MARCH2: Comparative Assessment of Therapeutic Effects of Acarbose and Metformin in Newly Diagnosed Type 2 Diabetes Patients

Cited by 21 publications

References 35 publications

NETosis before and after Hyperglycemic Control in Type 2 Diabetes Mellitus Patients

NETosis before and after Hyperglycemic Control in Type 2 Diabetes Mellitus Patients

Baseline Body Mass Index and the Efficacy of Hypoglycemic Treatment in Type 2 Diabetes: A Meta-Analysis

Factors that influence the efficacy of acarbose and metformin as initial therapy in Chinese patients with newly diagnosed type 2 diabetes: a subanalysis of the MARCH trial

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