title: Glycemic excursions are positively associated with HbA1c reduction from baseline after treatment with acarbose in patients with type 2 diabetes on metformin monotherapy.
abstract: BACKGROUND
  The aim of the present study was to examine the association between glycemic excursions before treatment and HbA1c reduction after treatment intensification with acarbose or glibenclamide in patients with type 2 diabetes (T2D).
  
  
  METHODS
  Patients receiving single or dual oral antidiabetic drug treatment with an HbA1c of 7.0-11.0 % (53-97 mmol/mol) were switched to metformin monotherapy (500 mg, t.i.d.) for 8 weeks, followed by randomization to either acarbose (100 mg, t.i.d.) or glibenclamide (5 mg, t.i.d.) as add-on treatment for 16 weeks. Glycemic excursions were assessed as mean amplitude of glycemic excursions (MAGE) with 72-h ambulatory continuous glucose monitoring. Treatment efficacy was evaluated as relative HbA1c reduction (%), calculated as (baseline HbA1c - post-treatment HbA1c)/baseline HbA1c × 100.
  
  
  RESULTS
  Fifty patients (mean [±SD] age 53.5 ± 8.2 years, 48 % men, mean baseline HbA1c 8.4 ± 1.2 %) were analyzed. Baseline MAGE was positively correlated with relative HbA1c reduction from baseline in patients treated with acarbose (r = 0.421, P = 0.029) but not glibenclamide (r = 0.052, P = 0.813). Linear regression analysis revealed that the association between baseline MAGE and relative HbA1c reduction from baseline (β = 0.125, P = 0.029) in patients treated with acarbose remained significant after adjustment for several confounders (P < 0.05 for all models).
  
  
  CONCLUSIONS
  In patients with T2D on metformin monotherapy, baseline MAGE was positively correlated with relative HbA1c reduction from baseline after treatment with acarbose, but not glibenclamide. These findings highlight the importance of glycemic excursions in individualized treatment for patients with T2D.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jun-Sing
authors.initials: JS
authors.lastname: Wang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: I-Te
authors.initials: IT
authors.lastname: Lee
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Wen-Jane
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Hua Christian Hospital, Chang-Hua, Taiwan.
authors.forename: Shi-Dou
authors.initials: SD
authors.lastname: Lin
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Hua Christian Hospital, Chang-Hua, Taiwan.
authors.forename: Shih-Li
authors.initials: SL
authors.lastname: Su
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang-Hua Christian Hospital, Chang-Hua, Taiwan.
authors.forename: Shih-Te
authors.initials: ST
authors.lastname: Tu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Yao-Hsien
authors.initials: YH
authors.lastname: Tseng
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Center of Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Lin
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan.|Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wayne Huey-Herng
authors.initials: WH
authors.lastname: Sheu
mesh_terms: D020909:Acarbose / Q000627:therapeutic use*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005905:Glyburide / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D065089:Glycoside Hydrolase Inhibitors / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D020909:Acarbose; D001786:Blood Glucose; D005905:Glyburide; D006442:Glycated Hemoglobin; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Acarbose; HbA1c; continuous glucose monitoring; glycemic excursions; type 2 diabetes; 阿卡波糖,连续血糖监测,血糖波动,糖化血红蛋白,2型糖尿病