title: 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.
abstract: OBJECTIVE
  To conduct a subanalysis of the randomized MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycemic treatment) trial to investigate whether specific characteristics are associated with the efficacy of either acarbose or metformin as initial therapy.
  
  
  METHODS
  A total of 657 type 2 diabetes patients who were randomly assigned to 48 weeks of therapy with either acarbose or metformin in the MARCH trial were divided into two groups based upon their hemoglobin A1c (HbA1c) levels at the end of follow-up: HbA1c <7% (<53 mmol/mol) and ≥7% (≥53 mmol/mol). Univariate, multivariate, and stepwise linear regression analyses were applied to identify the factors associated with treatment efficacy.
  
  
  METHODS
  Because this was a subanalysis, no measurement was performed.
  
  
  RESULTS
  Univariate analysis showed that the efficacy of acarbose and metformin was influenced by HbA1c, fasting blood glucose (FBG), and 2 hour postprandial venous blood glucose (2hPPG) levels, as well as by changes in body mass index (BMI) (p ≤ 0.006). Multivariate analysis and stepwise linear regression analyses indicated that lower baseline 2hPPG values and greater changes in BMI were factors that positively influenced efficacy in both treatment groups (p ≤ 0.05). Stepwise regression model analysis also revealed that a lower baseline homeostasis model assessment-estimated insulin resistance (HOMA-IR) and higher serum insulin area under the curve (AUC) were factors positively influencing HbA1c normalization in all patients (p ≤ 0.032).
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China.
authors.forename: Jinping
authors.initials: J
authors.lastname: Zhang
authors.affiliation: a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China.
authors.forename: Na
authors.initials: N
authors.lastname: Wang
authors.affiliation: a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Xing
authors.affiliation: a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China.
authors.forename: Zhaojun
authors.initials: Z
authors.lastname: Yang
authors.affiliation: a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.affiliation: a Department of Endocrinology , China-Japan Friendship Hospital , Beijing , China.
authors.forename: Wenying
authors.initials: W
authors.lastname: Yang
mesh_terms: D020909:Acarbose / Q000008:administration & dosage*; D000328:Adult; D019540:Area Under Curve; D044466:Asian People; D001786:Blood Glucose; D015992:Body Mass Index; D002681:China; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007333:Insulin Resistance; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D015999:Multivariate Analysis; D019518:Postprandial Period; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D020909:Acarbose; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Acarbose; glucose control; hemoglobin A1c; metformin; type 2 diabetes