Nateglinide and Acarbose Are Comparably Effective Reducers of Postprandial Glycemic Excursions in Chinese Antihyperglycemic Agent–Naive Subjects with Type 2 Diabetes

Abstract

Background: Recent studies have identified postprandial glycemic excursions as risk factors for diabetes complications. This study aimed to compare the effects of nateglinide and acarbose treatments on postprandial glycemic excursions in Chinese subjects with type 2 diabetes. Subjects and Methods: This was a multicenter, open-label, randomized, active-controlled, parallel-group study. One hundred three antihyperglycemic agent-naive subjects with type 2 diabetes (hemoglobin A1c range, 6.5-9.0%) were prospectively recruited from four hospitals in China. The intervention was nateglinide (120 mg three times a day) or acarbose (50 mg three times a day) therapy for 2 weeks. A continuous glucose monitoring system was used to calculate the incremental area under the curve of postprandial blood glucose (AUC pp ), the incremental glucose peak (IGP), mean amplitude of glycemic excursions, SD of blood glucose, the mean of daily differences, and 24-h mean blood glucose (MBG). Subjects' serum glycated albumin and the plasma insulin levels were also analyzed. Results: Both agents caused significant reductions on AUC pp and IGP. Similarly, both treatment groups showed significant improvements in the intra-and interday glycemic excursions, as well as the 24-h MBG and serum glycated albumin compared with baseline (P < 0.001). However, neither of the agents produced a significantly better effect (P > 0.05). Moreover, the nateglinide-treated group had significantly increased insulin levels at 30 min and at 120 min after a standard meal compared with baseline, whereas the acarbose-treated group decreased. No serious adverse events occurred in either group. The rates of hypoglycemic episodes were comparable in the two groups, and no severe hypoglycemic episode occurred in either group. Conclusions: Nateglinide and acarbose were comparably effective in reducing postprandial glycemic excursions in antihyperglycemic agent-naive Chinese patients with type 2 diabetes, possibly through different pathophysiological mechanisms.

Effect of Acarbose on Glycemic Variability in Patients with Poorly Controlled Type 2 Diabetes Mellitus Receiving Stable Background Therapy: A Placebo‐Controlled Trial

“…The novel finding of our study, however, is the positive effect of acarbose on glycemic variability when added to metformin and vildagliptin therapy. Our results are in line with the findings of a study in which 103 antihyperglycemic agent–naive patients with type 2 diabetes were prospectively randomized to nateglinide 120 mg 3 times/day or acarbose 50 mg 3 times/day for 2 weeks . Both agents caused significant reductions on the incremental AUC of the postprandial glucose level and the incremental glucose level peak.…”

Safety and efficacy of acarbose in the treatment of diabetes in Chinese patients

“…Several short-term (2–9 weeks) studies in the People’s Republic of China have confirmed that acarbose exerts similar hypoglycemic effects as nateglinide, particularly on postprandial glucose,27–29 although there were obvious differences in the mechanism of action of the two drugs. Nateglinide is an insulinotropic agent that exerts effects on β-cells to enhance early-phase insulin secretion 30,31.…”

Differential Therapeutic Effects of Nateglinide and Acarbose on Fasting and Postprandial Lipid Profiles: A Randomized Trial

“…8 The study protocol was designed in accordance with the principles of the Helsinki Declaration II and carried out with pre-approval by the Independent Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Shanghai, People's Republic of China). All study participants provided written informed consent.…”

“…The treatment strategy has been illustrated in our previous study. 8 Anthropometric and biochemical measurements Upon enrollment, blood pressure was measured in triplicate using a standard mercury sphygmomanometer, and the average measurement was recorded. Body mass index was calculated as weight (in kg)/height (in m) 2 .…”

“…Our studies and those of other researchers have demonstrated that both nateglinide and acarbose can reduce postprandial hyperglycemia 6,7 and are comparably effective in reducing postprandial glycemic excursions. 8 However, the effects of nateglinide and acarbose on lipid profiles remain inconclusive. [9][10][11][12][13] Moreover, only a few have conducted a direct comparison between the two agents.…”