Alpha-glucosidase inhibitors in the early treatment of type 2 diabetes

Figures & data

Table 1 Current definitions for diabetes mellitus, impaired glucose tolerance and impaired fasting blood glucose

	WHO 2006	ADA 2007	Rutten et al 2006
Diabetes mellitus	FPG ≥7.0 or 2HPG ≥11.1	Symptoms of diabetesa plus CPG ≥11.1 or FPG ≥7.0 or 2HPG ≥11.1b	Symptoms of diabetesa plus CPG ≥11.1 or FPG ≥7.0 on two occasions
Impaired glucose tolerance	FPG ≥7.0 and 2HPG 7.8–11.0	2HPG 7.8–11.0c	No definition
Impaired fasting blood glucose	FPG 6.1–6.9 and (if measured) 2HPG <7.8	FPG 5.6–6.9c	FPG > 6.1 and < 6.9c

Notes: All values are venous plasma glucose concentrations (mmol/L).

2HPG, 2 hours plasma glucose, glucose concentration 2 hours after ingestion of 75 g glucose; CPG, casual plasma glucose, casual is defined as any time of day without regard to time since last meal; FPG, fasting plasma glucose, fasting is defined as no caloric intake for ≥8 hours.

a The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss.

b These criteria should be confirmed by repeat testing ‘in the absence of unequivocal hyperglycemia’.

c Excluding patients fulfilling the criteria for type 2 diabetes.

Table 2 Results of overall Cochrane meta–analysis for the comparison of acarbose and miglitol versus placebo and sulphonylurea

Outcome	Placebo–controlled studies						Sulphonylurea controlled studies
	Acarbose			Miglitol			Acarbose			Miglitol
	Comp, parta	Effect Sizeb	95% CI	Comp, parta	Effect Sizeb	95% CI	Comp, parta	Effect Sizeb	95% CI	Comp, parta	Effect Sizeb	95% CI
GHb (%)	28, 2831	−0.77	−0.90, −0.64	7, 1088	−0.68	0.93, −0.44	8, 596	0.38	−0.02, 0.77	1, 90	0.40	−0.16, 0.96
Fasting blood glucose (mmol/l)	28, 2838	−1.09	−1.36, −0.83	2, 398	−0.52	−0.88, −0.16	8, 596	0.69	0.16, 1.23	1, 90	0.27	−0.74, 1.28
1-h postload blood glucose (mmol/L)	22, 2238	−2.32	−2.73, −1.92	2, 398	−2.70	−5.54, 0.14	8, 591	−0.10	−0.43, 0.22	1, 88	−0.60	−3.43, 2.23
Fasting insulin (pmol/L)	15, 1264	−0.5	−7.9, 6.9	1, 162	−18.2	−57.0, 20.6	7, 486	−24.8	−43.3, 6.3	1, 90	−44.8	−53.7, −35.8
1-hour postload insulin (pmol/L)	13, 1050	−40.8	−60.6, −21.0	2, 398	−16.6	−39.2, 6.0	7, 483	−133.2	−184.5, −81.8	ND	ND	ND
Total cholesterol (mmol/L)	23, 2133	0.00	−0.10, 0.09	ND	ND	ND	7, 499	−0.09	−0.23, 0.05	1, 88	0.08	−0.29, 0.45
HDL cholesterol (mmol/L)	14, 924	0.00	−0.04, 0.04	ND	ND	ND	7, 485	0.02	−0.02, 0.06	1, 86	−0.01	−0.26, 0.24
LDL cholesterol (mmol/L)	4, 402	−0.08	−0.41, 0.25	ND	ND	ND	4, 312	0.10	−0.07, 0.27	ND	ND	ND
Triglycerides (mmol/L)	21, 1969	−0.09	−0.18, 0.00	ND	ND	ND	8, 591	0.01	−0.18, 0.20	1, 89	−0.04	−0.40, 0.32
Body weight (kg)	16, 1451	−0.13	−0.46, 0.20	1, 162	0.27	−0.50, 1.04	5, 397	−1.90	−4.01, 0.21	1, 90	0.46	−0.48, 1.40
BMI (kg/m^2)	14, 1430	−0.17	−0.25, −0.08	ND	ND	ND	4, 230	−0.39	−0.83, 0.05	ND	ND	ND
Occurrence of any side effect	23, 3819	3.37	2.60, 4.36	7, 1304	4.01	1.69, 9.52	7, 607	3.95	2.00, 7.80	2, 232	1.29	0.69, 2.41

Notes: Continuous data are expressed as weighted mean differences. Occurrence of side effects is expressed as odds ratio. Results are calculated with a random effects model.

a Number of comparisons (comp), participants (part);

b A negative value indicates an advantage for acarbose or miglitol.

Abbreviations: GHb, glycated hemoglobin; ND, no available data.

WHO2006Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultationGeneva, SwitzerlandWorld Health Organization

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ADA2007Diagnosis and classification of diabetes mellitusDiabetes Care30S42S717192378

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RuttenGEHMDe GrauwWJCNijpelsG2006Dutch College of General Practitioners: guidelines on Type 2 diabetes, second revision (in Dutch)Huisarts Wet4913752

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