Acarbose: oral antidiabetes drug with additional cardiovascular benefits

Abstract

Acarbose is an α-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.

Keywords::

• acarbose
• cardiovascular disease
• impaired glucose tolerance
• prevention
• Type 2 diabetes

Financial & competing interests disclosure

Dr Hanefeld received honoria for lectures from BAYER AG. He is a member of steering committee in GSK (RECORD) and Sanofi-Aventis (DREAM, ORIGIN). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed..

No writing assistance was utilized in the production of this manuscript.