Cardiovascular Benefits of Acarbose vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin

Hsu, Powen; Sung, Shih Hsien; Cheng, Hao Min; Shin, Shyi Jang; Lin, Kun‐Der; Chong, Keong; Yen, Fu‐Shun; Yu, Ben Hui; Huang, Chih‐Cheng; Hsu, Chih Cheng

doi:10.1210/jc.2018-00040

Cited by 30 publications

(18 citation statements)

References 40 publications

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“…The GRADE randomized control study investigated the long-term outcomes of glimepiride, sitagliptin, liraglutide, and basal insulin glargine; however, this study is ongoing and thus the results remain unknown [21]. Several studies have compared the clinical outcomes of different second-line OADs added to metformin [22][23][24]. Morgan et al reported that the combination of metformin plus pioglitazone was associated with a lower risk of combined end points (mortality, CV events, and cancer) compared with the combination of metformin plus SU [22].…”

Section: Resultsmentioning

confidence: 99%

“…Further, Chang et al revealed that glinide plus metformin and AGIs plus metformin were associated with lower risks of acute myocardial infarction compared with SU plus metformin [23]. Hsu et al demonstrated that acarbose added to metformin was associated with lower risks of major atherosclerotic events compared with the addition of SU to metformin [24]. Few clinical studies have compared the clinical outcomes of different treatments for diabetes in patients with YOD.…”

Section: Resultsmentioning

confidence: 99%

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Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

Yen

Wei

Liu

et al. 2020

Preprint

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Background: People with young-onset diabetes (YOD) exhibit a higher risk of morbidity and mortality than those with late-onset diabetes. Few studies have explored the preferred management of diabetes in such patients; therefore, we compared the risks of hospitalization and mortality among people with YOD to whom second-line oral antidiabetic drugs (OADs) were administered.Methods: We conducted a nationwide cohort study using the National Health Insurance Research Database (Taiwan). A total of 7257 people taking second-line OADs after initial metformin therapy were enrolled during 2009–2014. Using add-on sulfonylureas (SUs) as a reference, the multivariable Cox regression model was used to compare the risks of hospitalization and mortality among 5 categories of second-line OADs: alpha-glucosidase inhibitors, meglitinide, dipeptidyl peptidase-4 (DPP-4) inhibitors, SUs, and thiazolidinediones.Results: The mean age of patients, duration of diabetes, and follow-up period were 31.6, 3.3, and 1.9 years, respectively. After baseline characteristics, comorbidities, duration of diabetes, and cardiovascular drug use were controlled, the adjusted hazard ratios and 95% confidence interval for all-cause, cardiovascular, and non-infection hospitalization and all-cause mortality for metformin plus DPP-4 inhibitors were 0.62 (0.52–0.73), 0.49 (0.29–0.85), 0.64 (0.54–0.76), and 0.50 (0.27–0.92), respectively, when compared with the data for metformin plus SUs.Conclusions: We found that among people with YOD, taking add-on DPP-4 inhibitors was associated with lower risks of all-cause hospitalization and mortality than taking add-on SUs. DPP-4 inhibitors thus seem to be a suitable second-line OAD for such patients.Trial registration: retrospectively registered

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

Yen

Wei

Liu

et al. 2020

Preprint

Self Cite

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“…In their nationwide cohort study, Chang et al demonstrated that metformin add-on AGI was associated with lower acute myocardial infarction risks compared with metformin add-on sulphonylurea [23]. Hsu et al compared the use of acarbose as an add-on treatment to metformin with sulfonylurea, and reported low myocardial infarction and ischemic stroke hospitalization risks, but no effect on all-cause mortality [24]. AGIs can reduce HbA1c, postprandial glucose levels, and glucose excursion [25].…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes of Adding Alpha-glucosidase Inhibitors in Insulin-treated Patients with type 2 Diabetes

Yen

Wei

Lin³

et al. 2020

Preprint

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Background: In insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal. Methods: This study compared the risks of mortality and cardiovascular events in insulin-treated patients adding or not adding alpha-glucosidase inhibitors (AGIs). Results: This cohort study included data from the Taiwan National Health Insurance Research Database. In total, 17,417 patients newly diagnosed as having T2DM and undergoing insulin therapy during 2000–2012 were enrolled. Overall incidence rates of all-cause mortality, hospitalized coronary artery disease (CAD), stroke, and heart failure were compared between 4165 AGI users and 4165 matched nonusers. The incidence rates of all-cause mortality were 17.10 and 19.61 per 1000 person-years in AGI nonusers and users, respectively. Compared with nonusers, AGI users had a higher mortality risk [adjusted hazard ratio (aHR) = 1.21, 95% confidence interval (CI) = 1.05–1.40; p = 0.01]. Regarding AGI use, aHRs (95% CI) for cardiovascular death, non-cardiovascular death, hospitalized CAD, stroke, and heart failure were 1.20 (0.83–1.74), 1.27 (1.07–1.50), 1.12 (0.95–1.31), 0.98 (0.85–1.14), and 1.03 (0.87–1.22) respectively. Conclusion: AGI use was associated with higher risks of all-cause mortality and non-cardiovascular death in insulin-treated patients with T2DM. Therefore, adding AGIs in insulin-treated patients may not be appropriate.

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“…Metformin use has also been associated with cognitive improvement in patients with particular forms of dementia [14]. Acarbose use is associated with cardiovascular benefits in diabetic patients [15,16] and has been shown to be protective against atherosclerosis and myocardial infact in laboratory animal models [17,18]. Acarbose has been shown to prevent liver injury in diabetic patients [19].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the pharmacokinetics of metformin and acarbose in the common marmoset

Fernández

Ross

Liang

et al. 2019

Pathobiology of Aging & Age-related Diseases

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Metformin has beneficial effects on several age-related diseases (e.g., diabetes, obesity, cancer) and extends lifespan in nematodes and mice. Acarbose, an FDA-approved agent for treating type 2 diabetes, prevents breakdown of complex carbohydrates. Both compounds have been suggested as potential anti-aging interventions and acarbose has been shown to extend mouse longevity by the Intervention Testing Program (ITP). One potential next step is to assess the effect of these interventions on healthspan and lifespan in non-human primates. The common marmoset (Callithrix jacchus) is a small new world monkey with a relatively short life span and small size, both valuable for the translation potential of this nonhuman primate species for the study of aging and chronic disease. However, the dosing and assessment of potential side effects of either metformin or acarbose in this species have yet to be assessed. This study evaluated the pharmacokinetics of two dosage levels each of metformin or acarbose (given separately) in two small groups of young marmosets (n = 5/group) treated for 24 h to define the pharmacokinetics of each drug. The ability to rapidly and reliably dose socially housed marmosets with an oral form of acarbose or metformin that is well tolerated indicates that this species is a reliable model for testing acarbose and metformin in a safe and efficient way in a long-term intervention.

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Cardiovascular Benefits of Acarbose vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin

Abstract: In T2D treatment, the use of acarbose as an add-on remedy to metformin was associated with lower risks of major atherosclerotic events, ischemic stroke, and hypoglycemia compared with the use of sulfonylurea as an add-on remedy.

Cited by 30 publications

References 40 publications

Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

Do second-line oral antidiabetic drugs have different long-term effects on persons with young-onset type 2 diabetes? ---A nationwide population base cohort study

Long-term Outcomes of Adding Alpha-glucosidase Inhibitors in Insulin-treated Patients with type 2 Diabetes

Evaluation of the pharmacokinetics of metformin and acarbose in the common marmoset

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