Effects of acarbose and metformin on the inflammatory state in newly diagnosed type 2 diabetes patients: a one-year randomized clinical study

Abstract

Objective

This study aimed to investigate the changes in inflammatory biomarkers between newly diagnosed type 2 diabetes (T2DM) patients under one-year acarbose treatments and those under metformin managements.

Methods

Seventy patients with newly diagnosed T2DM and 32 volunteers with normal glucose tolerance (normal controls, NCs) were enrolled. Seventy patients with T2DM were randomly assigned to two subgroups and treated with acarbose (n=34) or metformin (n=36) for 1 year. Blood glucose, insulin, glycosylated hemoglobin (A1C), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and inflammatory biomarker levels (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-2 (IL-2), and ferritin) were detected at 0, 6 and 12 months.

Results

After adjusting for sex, the waist-to-hip ratio (WHR) and body mass index (BMI), higher fasting plasma glucose (FPG), standard meal test 1/2 hr and 2 hr glucose, TG, TC, LDL-C, IL-6, TNF-α, IL-2 and ferritin levels were observed in T2DM group than in NCs (P<0.05). After 6 months of treatment, TNF-α levels were significantly decreased in both subgroups, and IL-6 and ferritin levels were significantly decreased after 12 months (P<0.05). However, no significant differences in the IL-6, TNF-α and ferritin levels were observed between the two subgroups. Moreover, significantly higher IL-6 and TNF-α levels were detected in the T2DM group than in NCs after 12 months of treatment (P<0.05).

Conclusion

Patients with newly diagnosed T2DM exhibited a marked chronic inflammatory state characterized by increased IL-6, TNF-α, IL-1β, IL-2 and ferritin levels. After 1 year of treatment with acarbose or metformin, IL-6, TNF-α, IL-1β and ferritin levels were significantly decreased compared with the baseline. The anti-inflammatory effects of acarbose and metformin were comparable and required a long-term treatment (1 year), but the characteristics were different. Further investigations are needed to determine whether this effect was independent of the hypoglycemic effects.

Keywords:

• newly diagnosed type 2 diabetes
• inflammatory biomarkers
• acarbose
• metformin

Acknowledgments

This study was supported by the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (grant No. ZYGD18022), 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (grant No. ZYJC18023), and Sichuan Provincial Science and Technology Foundation (grant No. 2015SZ0228).

Ethics and consent statement

The Metformin and Acarbose in Chinese as the initial Hypoglycemic treatment (MARCH) Study (Registry number: ChiCTR-TRC-08000231) compared the medical outcomes of two different glycemic treatment approaches. This study was a non-inferiority, multicenter randomized controlled trial that tested two drug interventions (metformin and acarbose). Our study was performed at one of the 11 clinical sites in China invited to participate, which had received ethical approval. All trial participants who were enrolled in the present study provided written informed consent (no additional registration of RCT), and the study was performed in accordance with the principles of the Declaration of Helsinki.

Disclosure

The authors report no conflicts of interest in this work.