Acarbose: oral anti-diabetes drug with additional cardiovascular benefits.
Acarbose is an alpha-glucosidase inhibitor acting specifically at the level of postprandial glucose excursion. This compound lowers HbA(1c) by 0.5-1% in patients with Type 2 diabetes, either drug naive or in combination with other antidiabetic drugs. In those with impaired glucose tolerance (IGT), it reduces the incidence of newly diagnosed diabetes by 36.4%. Furthermore, it has beneficial effects on overweight, reduces blood pressure and triglycerides, and downregulates biomarkers of low-grade inflammation. In the Study To Prevent Non-Insulin-Dependent-Diabetes-Mellitus (STOP-NIDDM) trial, acarbose significantly reduced the progression of intima media thickness, incidence of cardiovascular events and of newly diagnosed hypertension. In a meta-analysis of patients with Type 2 diabetes (MERIA), acarbose intake was associated with a reduction of cardiovascular events by 35%. Acarbose is a very safe drug but in approximately 30% of patients, it can cause gastrointestinal complaints due to its mode of action, which in the majority disappear after 1-2 months. Acarbose is approved for treatment of IGT in 25 countries. It can be given alone or in combination with other oral antidiabetics and insulin. Acarbose is particularly effective in those with IGT and early diabetes and patients with comorbidities of the metabolic syndrome.
Hanefeld
Markolf
M
Centre for Clinical Studies, Dresden, Fiedlerstrasse 34, 01307 Dresden, Germany. hanefeld@gwtonline-zks.de
Schaper
Frank
F
D020909:Acarbose / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001808:Blood Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D018450:Disease Progression; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D018149:Glucose Intolerance / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D005959:Glucosidases / Q000037:antagonists & inhibitors; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014463:Ultrasonography
D004791:Enzyme Inhibitors; D007004:Hypoglycemic Agents; D005959:Glucosidases; D020909:Acarbose