DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20210873

An open randomized study to compare effect of metformin versus acarbose monotherapy on glycemic control and lipid profile in newly diagnosed type 2 diabetes mellitus patients

Ram A. Manda, Veena Verma, Krishna Biswas

Abstract


Background: Type 2 DM is one global health problem and a main cause of morbidity and mortality. It is epidemic in many industrialized and developing areas and is considered to be one of the most challenging health problems of the 21st century. Metformin and acarbose both are used as monotherapy and in combination with other anti-diabetes drugs for treatment of type 2 DM. There are very sparse evidences regarding comparative efficacy and safety of metformin versus acarbose, especially in Asian region. In addition to glycemic control, improvement in lipid profile, weight loss and post-prandial sugar level are important therapeutic objectives for better management of type 2 DM patients.

Methods: In this study, 60 newly diagnosed type 2 DM were randomly assigned (1:1) to oral acarbose (titrated doses upto 300 mg daily) or oral metformin (titrated doses up to 2500 mg daily) monotherapy and were followed-up for 12 weeks for effects on glycaemic control [serum HbA1C, fasting blood sugar and post prandial sugar and serum LDL, HDL, triglycerides and total cholesterol.

Results: Reduction in FBS, HbA1C and body weight was found significantly greater with metformin while acarbose yielded greater improvement in PPS, total cholesterol and triglyceride levels. Both metformin and acarbose yielded significant improvement in FBS, PPS, HbA1C, lipid profile and body weight after 12 weeks of therapy and yielded similar improvement in LDL and HDL levels.

Conclusions: Acarbose can be considered as an alternative initial therapy in newly diagnosed type 2 diabetes patients, particularly those with isolated post-prandial hyperglycemia and those who are intolerant to metformin therapy.

 


Keywords


Metformin, Acarbose, Type 2 diabetes, Post-prandial hyperglycemia, Lipid profile

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References


IDF Diabetes Atlas [Internet]. Available at: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/13-diabetes-atlas-seventh-edition.html. Accessed on: 09 May 2019.

Rathmann W, Giani G. Global Prevalence of Diabetes: Estimates for the Year 2000 and Projections for 2030: Response to Wild et al. Diabetes Care. 2004;27(10):2568-9.

Standl E, Schnell O, Ceriello A. Postprandial Hyperglycemia and Glycemic Variability: Should we care? Diabetes Care. 2011;34(2):120-7.

Standl E, Schnell O. Alpha-glucosidase inhibitors 2012 – cardiovascular considerations and trial evaluation. Diabet Vasc Dis Res. 2012;9(3):163-9.

Zhu Q, Tong Y, Wu T, Li J, Tong N. Comparison of the Hypoglycemic Effect of Acarbose Monotherapy in Patients With Type 2 Diabetes Mellitus Consuming an Eastern or Western Diet: A Systematic Meta-analysis. Clin Therap. 2013;35(6):880-99.

Bischoff H. The mechanism of alpha-glucosidase inhibition in the management of diabetes. Clin Invest Med. 1995;18(4):303-11.

Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854-65.

Giaccari A, Giorda C, Riccardi G, De Micheli A, Bruno G, Monge L, et al. Comment on: Inzucchi et al. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach. Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364-79.

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-63.

Wang J, Tu S, Lee I, Lin S, Lin S, Su S, Lee W, Sheu W. Contribution of postprandial glucose to excess hyperglycaemia in Asian type 2 diabetic patients using continuous glucose monitoring. Diabet/Metab Res Rev. 2010;27(1):79-84.

Hoffmann J, Spengler M. Efficacy of 24-week monotherapy with acarbose, metformin, or placebo in dietary-treated NIDDM patients: the Essen-II Study. Am J Med. 1997;103:483-90.

Zhang MH. Treatment effect of metformin and acarbose in patients with type 2 diabetic insulin resistance. Jilin Med J. 2011;32:3682-3.

American Diabetes Association. Medical Management of Type 1 Diabetes. 7th ed. Wang CC, Shah AC, Eds. Alexandria, VA, American Diabetes Association, 2017.

American Diabetes Association. Medical Management of Type 2 Diabetes. 7th ed. Burant CF, Young LA, Eds. Alexandria VA. American Diabetes Association. 2012.

Pan Q, Xu Y, Yang N, Gao X, Liu J, Yang W, Wang G. Comparison of Acarbose and Metformin on Albumin Excretion in Patients With Newly Diagnosed Type 2 Diabetes. Medicine. 2016;95(14):3247.

Gu S, Shi J, Tang Z. Comparison of glucose lowering effect of metformin and acarbose in type 2 diabetes mellitus: a meta-analysis. PLoS One. 2015;10(5):126704.

Pan Q, Xu Y, Yang N, Gao X, Liu J, Yang W, Wang G. Comparison of Acarbose and Metformin on Albumin Excretion in Patients With Newly Diagnosed Type 2 Diabetes. Medicine. 2016;95(14):3247.