Acarbose revisited for efficacy, safety and cardiovascular benefits: a key role for controlling glycemic variability

Abstract

There is a growing body of evidence to illustrate the effect of postprandial hyperglycemia (PPHG) in cardiovascular disease development and as a key component of diurnal hyperglycemia. Agents such as acarbose, which has been shown to reduce 24-h glycemia and glycated hemoglobin (mainly via its effects on PPHG), may have the potential to reduce the risk of adverse cardiovascular outcomes as indicated in secondary analyses of the STOP-NIDDM trial. Although the results of the NAVIGATOR trial showed no effect of PPHG reduction on cardiovascular outcomes, acarbose has a different mode of action to nateglinide. This could lead to marked cardiovascular differences, and it is important to fully investigate this. The ongoing ACE trial will determine the effect of acarbose on a composite primary end point of cardiovascular outcomes.

Keywords::

• acarbose
• cardiovascular disease
• glycemic variability
• PPHG
• Type 2 diabetes

Financial & competing interests disclosure

The author has no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing assistance was utilized in the preparation of this manuscript and was provided by PAREXEL MMS.