Comparison of acarbose and metformin therapy in newly diagnosed type 2 diabetic patients with overweight and/or obesity

Abstract

Objective: To compare the efficacy of acarbose and metformin in overweight and/or obese patients with newly diagnosed type 2 diabetes mellitus (T2DM).

Methods: A total of 108 drug-naïve patients with newly diagnosed T2DM, whose hemoglobin A1c (HbA1c) was between 7% and 10% and body mass index was greater than 24 kg/m², were enrolled in the First People’s Hospital and Municipal Central Hospital of Xiangtan City, Xiangtan, China, from 1 February 2010 to 1 August 2011. Patients were randomly assigned to acarbose (100 mg three times a day) and metformin (1.5 g/day) groups for a predictive follow-up period of 24 weeks. Plasma glucose, insulin, and glucagons at 0, 0.5, and 2 hours after a standardized meal, and HbA1c were measured at baseline and 24 weeks.

Results: Baseline characteristics of the acarbose and metformin groups were similar. Glucose control improved significantly in both groups at 24 weeks. The percentage of patients achieving HbA1C <6.5% was comparable for acarbose and metformin therapy at 24 weeks. Body weight reduction from baseline to 24 weeks was 3.3 kg in the acarbose group and 2.7 kg in the metformin group, whereas the change in HbA1c and body weight was similar in both groups. The early-phase insulin secretion index improved only in the acarbose group at 24 weeks. After 24 weeks of therapy, fasting glucagon and 0.5 hour postprandial glucagon levels decreased markedly in the acarbose group compared to the metformin group.

Conclusions: Twenty-four weeks of therapy with acarbose and metformin induced similar reductions in HbA1c and body weight, but acarbose showed superior efficacy in improving islet α-cell function compared with metformin in overweight/obese patients with newly diagnosed T2DM. However, more large-sample, multicenter, randomized controlled trials are needed to evaluate the efficacy, safety, cost-effectiveness, and glycemic variability of the two drugs.

Keywords:

• Acarbose
• glucagon
• metformin
• obese
• type 2 diabetes

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

W.S., C.Z., L.L., J.C., and Y.W. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

C.M.R.O. peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We would like to express our gratitude to Hua Liang for her constructive discussion of the manuscript.