Meta-analysis of the impact of alpha-glucosidase inhibitors on incident diabetes and cardiovascular outcomes

Abstract

Background Alpha-glucosidase inhibitors (AGIs) have been shown to reduce incident type 2 diabetes but their impact on cardiovascular (CV) disease remains controversial. We sought to identify the overall impact of AGIs with respect to incident type 2 diabetes in individuals with impaired glucose tolerance (IGT), and CV outcomes in those with IGT or type 2 diabetes. Methods We used PubMed and SCOPUS to identify randomized controlled trials reporting the incidence of type 2 diabetes and/or CV outcomes that had compared AGIs with placebo in populations with IGT or type 2 diabetes, with or without established CV disease. Eligible studies were required to have ≥ 500 participants and/or ≥ 100 endpoints of interest. Meta-analyses of available trial data were performed using random effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident type 2 diabetes and CV outcomes. Results Of ten trials identified, three met our inclusion criteria for incident type 2 diabetes and four were eligible for CV outcomes. The overall HR (95% CI) comparing AGI with placebo for incident type 2 diabetes was 0.77 (0.67–0.88), p < 0.0001, and for CV outcomes was 0.98 (0.89–1.10), p = 0.85. There was little to no heterogeneity between studies, with I2 values of 0.03% (p = 0.43) and 0% (p = 0.79) for the two outcomes respectively. Conclusions Allocation of people with IGT to an AGI significantly reduced their risk of incident type 2 diabetes by 23%, whereas in those with IGT or type 2 diabetes the impact on CV outcomes was neutral.

The Effects of Glucose Lowering Agents on the Secondary Prevention of Coronary Artery Disease in Patients with Type 2 Diabetes

“…We observed increased risk of repeated PCI among patients treated with insulin, SU, meglitinide and AGI. Coleman et al [ 31 ] suggested no overall impact of AGI on CV outcomes in a meta-analysis and concluded that AGIs would rather not be indicated for CV secondary prevention. There are ongoing debates regarding the use of insulin in patients at high risk of CAD.…”

Management of Hyperglycemia in Older Adults with Type 2 Diabetes

“…When used as monotherapy in patients with type 2 diabetes, the average reduction in HbA1c is 0.8% without risk of hypoglycemia [86]. While an earlier study suggested that acarbose may reduce the incidence of cardiovascular events [87], a recent meta-analysis comparing AGIs with placebo for cardiovascular outcomes suggested a neutral effect [88]. These agents can cause significant gastrointestinal adverse effects, including flatulence, diarrhea, and abdominal pain, resulting in poor adherence [89].…”

Maximizing treatment benefits in type 2 diabetes by affordable oral anti diabetes agents in India

“…45 To summarize, Table 6 provides an overview of the efficacy, CV safety and side effects of various classes of OADs. 47 Neutral effect on CV outcomes 48 Flatulence, diarrhea 49 Main for PPG, low risk of hypoglycemia, CV safety to be evaluated 48,50…”