Cardiovascular benefits and safety profile of acarbose therapy in prediabetes and established type 2 diabetes.
Dysglycaemic disease is one of the most important health issues facing the world in the 21st century. Patients with type 2 diabetes and individuals with prediabetes are at risk of developing macrovascular and microvascular complications. Long-term management strategies are therefore required that are effective at controlling dysglycaemia, well tolerated and, ideally, offer additional cardiovascular disease (CVD) risk-reduction benefits. The efficacy, safety and tolerability of the alpha-glucosidase inhibitor acarbose have been well-established in a wide range of patient populations in both clinical and community trials. In addition, acarbose has been shown to reduce cardiovascular complications in type 2 diabetes and prevent hypertension and CVD in individuals with impaired glucose tolerance (IGT). Acarbose has a very good safety profile and, owing to its straightforward, non-systemic mode of action, avoids most adverse events. The most common side-effects of acarbose are mild-to-moderate gastrointestinal complaints that subside as treatment continues. They can be minimised through the use of an appropriate stepwise dosing regimen and careful choice of diet. Acarbose is therefore a valuable option for the management of type 2 diabetes and, as the only oral antidiabetes agent approved for the treatment of prediabetes, can help to improve clinical management across the dysglycaemic disease continuum.
Hanefeld
Markolf
M
Zentrum für Klinische Studien, GWT, Technische Universität Dresden, Dresden, Germany. hanefeld@gwtonline-zks.de
D020909:Acarbose / Q000627:therapeutic use*; D002318:Cardiovascular Diseases; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D011236:Prediabetic State / Q000188:drug therapy*; D000077154:Rosiglitazone; D012449:Safety; D045162:Thiazolidinediones / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D008687:Metformin; D020909:Acarbose
Drugs. 1992;44 Suppl 3:47-53
1280577
Clin Gastroenterol Hepatol. 2005 Feb;3(2):184-91
15704053
Lancet. 2005 Apr 16-22;365(9468):1415-28
15836891
Diabetes Res Clin Pract. 1998 Jul;40 Suppl:S51-5
9740503
Diabetes Care. 2005 Jan;28(1):154-63
15616251
Drugs. 1992;44 Suppl 3:13-20
1280573
Am J Health Syst Pharm. 1996 Oct 1;53(19):2277-90; quiz 2336-7
8893066
Diabetes Care. 2005 Apr;28(4):888-94
15793191
Diabet Med. 1995 Nov;12(11):979-84
8582130
Horm Metab Res. 2004 Sep;36(9):630-8
15486815
Circulation. 2004 May 11;109(18):2197-202
15123532
Diabetologia. 1996 Dec;39(12):1577-83
8960845
Diabetologia. 1999 Sep;42(9):1050-4
10447514
Diabetes Care. 1998 Apr;21(4):518-24
9571335
Diabetes Care. 1994 Jun;17(6):561-6
8082525
Arch Intern Med. 2001 Feb 12;161(3):397-405
11176766
Diabet Med. 2004 Mar;21(3):208-13
15008828
Drugs. 2005;65(3):385-411
15669880
Diabetes Res Clin Pract. 2003 Sep;61(3):183-90
12965108
Diabetes Res Clin Pract. 2003 Jan;59(1):37-42
12482640
Ann Intern Med. 1998 Feb 1;128(3):165-75
9454524
Minerva Endocrinol. 2004 Jun;29(2):31-45
15257254
Lancet. 2002 Jun 15;359(9323):2072-7
12086760
Lancet. 1997 Mar 8;349(9053):698-9
9078205
Stroke. 2004 May;35(5):1073-8
15073402
Ann Intern Med. 1996 May 15;124(10):931
8610937
Clin Ther. 1998 Mar-Apr;20(2):257-69
9589817
JAMA. 2003 Jul 23;290(4):486-94
12876091
Diabetes Care. 1999 Feb;22(2):233-40
10333939
Lancet. 1998 Sep 12;352(9131):854-65
9742977
Lancet. 1998 Sep 12;352(9131):837-53
9742976
Scand J Gastroenterol. 1995 Sep;30(9):892-6
8578189
Diabetes Care. 1999 Jun;22(6):920-4
10372242
Am J Cardiol. 2007 Apr 1;99(7):1006-12
17398202
Am Heart J. 2004 May;147(5):803-7
15131534
Diabet Med. 2000 Jan;17(1):20-5
10691155
Clin Drug Investig. 2005;25(10):651-9
17532710
CMAJ. 2005 Jan 18;172(2):213-26
15655244
Diabetologia. 2002 Jul;45(7):937-48
12136392
Diabetes Care. 1999 Jul;22(7):1217-8
10388994
Acta Diabetol. 1998 Apr;35(1):34-40
9625287
Eur J Cardiovasc Prev Rehabil. 2004 Oct;11(5):412-5
15616415
Diabetes Nutr Metab. 1999 Aug;12(4):277-85
10782754
Eur Heart J. 2005 Oct;26(19):2032-8
15872029
Diabetes. 2005 Apr;54(4):1150-6
15793255
Am J Med. 1997 Dec;103(6):483-90
9428831
Diabetes Care. 2004 Jan;27 Suppl 1:S65-7
14693929
Diabetes. 1981 Nov;30(11):951-4
7028548
Lancet. 2006 Sep 23;368(9541):1096-105
16997664
N Engl J Med. 2001 May 3;344(18):1343-50
11333990
Med Clin North Am. 2004 Jul;88(4):1107-16, xii-xiii
15308392
Diabetes Care. 1998 Oct;21(10):1720-5
9773737
J Gerontol A Biol Sci Med Sci. 2006 Oct;61(10):1075-81
17077202
Cardiovasc Res. 1997 Apr;34(1):248-53
9217897
Diabetes Care. 2000 Aug;23(8):1162-7
10937515
Diabetes Res Clin Pract. 2002 Mar;55(3):221-7
11850098
Diabetes Care. 1999 Jun;22(6):960-4
10372249
N Engl J Med. 2002 Feb 7;346(6):393-403
11832527
J Gastroenterol. 1997 Dec;32(6):777-82
9430016
Clin Invest Med. 1995 Aug;18(4):303-11
8549017
Lancet. 2005 Oct 8;366(9493):1279-89
16214598
Diabetes Care. 1993 Feb;16(2):434-44
8432214
Diab Vasc Dis Res. 2006 Dec;3(3):147-58
17160909
Diabetes Res Clin Pract. 2001 Jun;52(3):193-204
11323089
Braz J Med Biol Res. 2002 Aug;35(8):877-84
12185379
Eur J Clin Invest. 2005 Sep;35(9):551-7
16128861
Int J Obes Relat Metab Disord. 1997 Sep;21(9):756-63
9376887
Exp Clin Endocrinol Diabetes. 2003 Oct;111(7):405-14
14614647
Eur Heart J. 2004 Jan;25(1):10-6
14683737
Diabetes Care. 1999 Nov;22(11):1827-31
10546015
Diabetes Care. 2001 Aug;24(8):1397-402
11473076