Impact of baseline characteristics on glycemic effects of add‐on saxagliptin or acarbose to metformin therapy: Subgroup analysis of the SMART study in Chinese patients with type 2 diabetes mellitus

Abstract

Aims/Introduction: This secondary analysis of the 24-week SMART study examined the efficacy of add-on saxagliptin or acarbose to metformin across different patient subgroups with type 2 diabetes mellitus, based on baseline characteristics. Materials and Methods: Randomized patients (n = 481) were classified into subgroups based on their baseline age (<65, ≥65 years), body mass index (BMI; <24, 24-<28, ≥28 kg/m 2), glycated hemoglobin (HbA1c; <8%, 8-<9%, 9-<10%, ≥10%) and renal function (creatinine clearance 50-<80, ≥80 mL/min). Treatment effects on primary outcome (HbA1c) and key secondary outcomes of fasting plasma glucose (FPG), 2-h postprandial glucose and homeostatic model assessment of b-cell function were assessed across patient subgroups. Results: For saxagliptin, reductions in HbA1c from baseline to week 24 were consistent across different subgroups regardless of baseline age, body mass index, HbA1c and renal function (range-0.66 to-1.16%). Saxagliptin was associated with consistent reductions in FPG (-0.60 to-1.33 mmol/L) and 2-h postprandial glucose (-0.48 to-1.95 mmol/L) across the majority of subgroups studied. The efficacy of acarbose on FPG attenuated progressively with increasing baseline HbA1c (+0.86 to-1.43 mmol/L); an increase from baseline FPG was observed in patients with HbA1c >9%. The effect of acarbose on postprandial glucose was also variable (+0.23 to-3.38 mmol/L). Conclusions: As add-on to metformin, both saxagliptin and acarbose reduced HbA1c regardless of baseline HbA1c, age, body mass index and renal function; however, only saxagliptin was effective at a stable glycemic control (FPG and PPG). The efficacy of acarbose on FPG and PPG was significantly attenuated in patients with higher baseline HbA1c (≥8%). diabetes worldwide, with a prevalence of 10.9% (114 million) among adults aged 20-79 years; approximately 90% of these patients have type 2 diabetes 1. The high prevalence of type 2 diabetes and the corresponding costs of its associated complications place a considerable strain on China's public health services 1-3 .

Pharmacodynamic comparison of acarbose tablets in Chinese healthy volunteers under chewing and swallowing conditions

“…Acarbose, a biosynthetic hypoglycaemic drug used to treat type 2 diabetes, was the first alpha-glucosidase inhibitor approved by the US Food and Drug Administration (FDA). [1][2][3] It is a pseudo-carbohydrate that prevents the breakdown of complex carbohydrates into monosaccharides (e.g. glucose) and inhibits glycoside hydrolases that are important for carbohydrate digestion.…”