Reducing the Risk of Type 2 Diabetes - Early Identification of High-Risk Individuals and Treatment with Acarbose

Abstract

The severity of the type 2 diabetes epidemic is widely acknowledged. Demographic, social, and cultural changes around the world are driving a dramatic increase in the prevalence of type 2 diabetes. Consequently, there is increasing interest in defining the target population and developing strategies for preventing or delaying the disease. Impaired glucose tolerance (IGT), an asymptomatic condition early in the disease continuum of dysglycemia, is the best target for intervention, as it is a strong predictor for the development of both type 2 diabetes and cardiovascular disease (CVD). Identifying individuals likely to have IGT using risk-prediction tools is simple and cost-effective; diagnosis can be confirmed with an oral glucose tolerance test. Numerous trials have examined the benefits of intervention in IGT populations. Lifestyle modification and some pharmacologic therapies, such as acarbose, have been shown to significantly reduce disease progression. Acarbose therapy has also been associated with significant reductions in cardiovascular events and new cases of hypertension. Trials assessing the potential preventive effects of various therapies are ongoing, but current evidence confirms that early intervention in individuals with IGT can reduce the risks of type 2 diabetes and CVD. Identification of high-risk individuals should therefore be standard in general practice and, if IGT is diagnosed, therapeutic intervention should be initiated promptly.

Clinical Analysis of Elderly Patients with Elderly-onset Type 2 Diabetes Mellitus in China: Assessment of Appropriate Therapy

“…Traditional Chinese diets are characterized and dominated by highglycaemic carbohydrates; 22 thus, α-glucosidase inhibitors are considered to be useful and relatively safe therapeutic options for elderly diabetes patients. 23,24 The overall control of cardiovascular risk factors is important to delay progression of type 2 diabetes in elderly patients. 25 In addition to hypoglycaemic agents, concomitant medications providing antihypertensive, antihyperlipidaemic and antiplatelet effects, and the use of nonsublingual nitrates, were extensively used in the present patient cohort, particularly the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, calcium channel blockers, aspirin and statins.…”

Progress in diabetes research in China

“…A potential explanation for this is that postprandial hyperglycemia may be dominant in prediabetic individuals. 30,31 Thus, several prospective studies in China have focused on comparing the effects of different interventions on the prevention of T2DM in people with IGT or the recovery of b-cell function in newly diagnosed T2DM patients (Table 1). [32][33][34][35][36][37] The Chinese DaQing diabetes prevention study, 32,33 a 20-year follow-up study, demonstrated the effects of diet and exercise in preventing T2DM in people with IGT, with the combined lifestyle interventions (diet only, exercise only, and diet plus exercise) leading to a 51% lower incidence of T2DM during the 6 year intervention and a 43% lower incidence of T2DM over the 20 year period compared with the control group.…”

“…Some studies have demonstrated that the contribution of postprandial hyperglycemia to HbA1c levels is greatest in individuals in the early stages of hyperglycemia or when diabetes is relatively well controlled. A potential explanation for this is that postprandial hyperglycemia may be dominant in prediabetic individuals 30,31 …”

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

“…Currently, international guidelines recommend the administration of metformin as a first-line oral antidiabetic drug 2 given its efficacy and safety 3,4 . Additionally, the α-glucosidase inhibitor, acarbose, is widely used in China as monotherapy for mild diabetes 5 , and multiple studies have shown it to reduce disease progression [6][7][8][9][10] .…”