[17] A study by Zhang et al. In both groups, CRP and EFT decreased significantly after the intervention, and the levels of CRP, EFT, and IMT markers in the acarbose group were significantly lower than control group (P value < 0.05). Accordingly, acarbose could be a convenient option for the long-term treatment irrespective of the diabetes duration. During periods of stress such as fever, trauma, infection, or surgery, management of diabetes may change and patients should be advised to seek medical advice. This might be related to patient selection such as selecting participants who suffer from inflammatory conditions other than cardiovascular inflammation. The quality of the included studies in the systematic review was evaluated by the Cochrane Collaboration tool, which is based on seven aspects (12). (2007) 26:454462. (2015) 373:23242. These findings of DPP-4is were in accordance with the previous studies (35, 36). In many patients, glycemic control may improve. As a result, further head-to-head studies are needed to assess the efficacy and tolerability as well as the cardiovascular safety between acarbose and DPP-4is in long-term clinical use. Scheen AJ, Esser N, Paquot N. Antidiabetic agents: Potential anti inflammatory activity beyond glucose control. The .gov means its official. doi: 10.1016/j.diabres.2015.02.022, 10. La Operacin Deluxe tiene mucho -o todo- que ver con el final de Slvame, previsto para el prximo viernes 23 de junio. Use of paired sample t-test for comparing mean variables after intervention versus before intervention in each group. Except for the results of the Asian subgroup analyses in the 2hPG (Figure S9A) and FPG (Figure S9B) changes, all the other outcomes were consistent. Acarbose oral tablet is a prescription drug used to treat type 2 diabetes. The continuous outcomes were expressed as a standardized mean difference, and dichotomous data were represented as a relative risk (RR), both with a 95% confidence interval. The crucial inclusion criteria were as follows: (1) patients were diagnosed as overweight or obese (BMI 25 kg/m 2 ); (2) randomized controlled trials (RCTs); (3) patients had undergone acarbose monotherapy or placebo control; (4) acarbose treatment had been carried out for at least 3 months. International Journal of Preventive Medicine. White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL, et al. Front. Cai X, Gao X, Yang W, Chen Y, Zhou L, Zhang S, et al. Therefore, compared with DPP-4is, acarbose might be more beneficial in overweight/obese T2D patients with their recommended dosages. (2019) 10:777. doi: 10.3389/fphar.2019.00777, 6. If elevated transaminase levels develop: Dose reduction or withdrawal of therapy may be necessary, especially if elevations persist. Patients should understand the importance of adhering to a diabetic diet; gastrointestinal side effects are common upon treatment initiation, but should diminish with time. Lau DC, Yan H, Dhillon B. Metabolic syndrome: A marker of patients at high cardiovascular risk. Due to the double blindness of the present study, the patient and the researcher were not aware of the contents of the packages. DPP-4, dipeptidyl peptidase-4. A study conducted by Nakhaee et al. Considering the FPG decrease, 37 studies with 7,683 individuals showed that pioglitazone had the best effect (MD 2.54 mmol/L, 95% CrI 3.45 to 1.59), followed by metformin (1.68, 2.43 to 0.92), acarbose (1.15, 1.63 to 0.66), DPP-4is (0.88, 1.19 to 0.57), and placebo in the rank order (Figures 3G-I). Queens of the Stone Age will bring Phantogram, Viagra Boys, the Armed, and Savages' Jehnny Beth on their fall North American tour. :\Z:d-``jke8[w ZMg1*1bg A 24-week placebo-controlled study. doi: 10.1016/j.clinthera.2012.04.013, 37. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Di Nicolantonio JJ, Bhutani J, O'Keefe JH. Acarbose reduces body weight irrespective of glycemic control in patients with diabetes: Results of a worldwide, non-interventional, observational study data pool. DPP-4is were superior to acarbose in withdrawal (RR 0.61, 95% CrI 0.390.98), gastrointestinal (0.14, 0.050.34) and overall AEs (0.27, 0.150.50). Compared with DPP-4is, acarbose led to more gastrointestinal (Figure S3C) and overall AEs (Figure S3E) in the monotherapy group (p < 0.05). The data that were used in our meta-analysis were intended for treatment. [19,20] Newer sulfonylurea drugs such as gliclazide and glimepiride are more efficient in reducing inflammatory markers compared to other drugs of this group. [25] The reason for these contradicting results maybe sex or ethnic differences or having other diseases such as diabetes or hypertension. Diabetes Care. A paired t-test was used to compare the mean of quantitative variables before and after intervention in both groups, and Chi-square test was used to compare the frequency distribution of gender between the two groups. doi: 10.1111/j.1464-5491.2008.02391.x, 7. Management of hyperglycemia in type 2 diabetes, 2018. a consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). However, acarbose was recently observed to decrease the fasting glucose and contribute to maintaining stable glucose levels (4, 20, 21). First, the control intervention, which bridges the comparison between acarbose and DPP-4is, should be the same and referring to the specific regimens and their doses. In order to obtain the best results, we chose a sufficiently long intervention duration in this study, whose included trials were of at least 24-week periods. demonstrated that acarbose reduces blood glucose 60 min after meals and keeps it low for 5 hours. Any discrepancy was resolved by mutual checks or consensus of all the authors. (1999) 22:9604. The patients were evaluated regarding the height and weight and after calculating BMI (BMI = weight/height2, weight [kg] and height [cm]) and the cases with BMI greater than or equal to 30 kg/m2 were included. Therefore, the similarities and divergences between acarbose and DPP-4is remain ambiguous, and the uncertainty regarding their efficacy and tolerability sometimes makes it tricky for clinicians to choose the appropriate treatment option. Foretz M, Guigas B, Bertrand L, Pollak M, Viollet M. Metformin: From mechanisms of action to therapies. DPP-4is had a greater glucose-lowering effect, but a weaker weight-loss effect than acarbose in pair-wise meta-analysis (p < 0.05). The research population included all the patients with MetS referred to Isfahan Endocrine and Metabolism Research Center between August 2016 and August 2017. A real-world study confirmed that the weight reduction effect of acarbose was sustainable over 5 years (24), whereas we need to identify the long-term weight effect of DPP-4is. There has been growing evidence suggesting that the inflammatory markers are the main causes of macro- and microvascular, including renal, ophthalmic, and cardiac, complications in patients with MetS who suffer from diabetes. Patients receiving sulfonylureas or insulin may need a dose adjustment of these agents if hypoglycemia occurs. doi: 10.1016/S0168-8227(01)00221-2, 25. Go to: Indications Acarbose is FDA approved for treating adults with type 2 diabetes mellitus as an adjunct to diet only or diet and exercise, depending on the patient's health status. Acarbose slows the carbohydrate absorption, and its hypoglycemic effect was only considered for decreasing the postprandial glucose excursions (18, 19). Diet guidelines Acarbose Orlistat (a lipase inhibitor, or fat-blocker) Low-dose Naltrexone (suppresses cravings) This 5-part regimen comprises our signature Nu Image WAYT-lessweight-loss program. Plenty of evidence has demonstrated that acarbose and DPP-4is at least have a weight-neutral effect (1, 2, 19, 37). [13] A study on 94 diabetic patients showed that acarbose alone can remarkably lower postprandial blood glucose. The underlying mechanisms are linked to the different dietary habits, insulin responses, BMI levels and genetic diversities. Since the aim was to concentrate on the hypoglycemic efficacies of acarbose and DPP-4is, our included trials were narrowed down to monotherapy, while several CVO trials, such as the SAVOR-TIMI 53, TECOS, EXAMINE, and CARMELINA studies, had patients with long diabetes durations who were receiving combined hypoglycemic therapies (2628, 41). Intriguingly, with the use of their most optimal dosages, the differences between the two drugs disappeared after longer treatment. Gastrointestinal adverse events such as flatulence (78%) and diarrhea (14%) are the most common side effects of this medication. doi: 10.2147/DMSO.S28340, 40. The HbA1c (n = 715, Figures S4A,B) and FPG (n = 509, Figures S4C,D) changes were not significantly different among acarbose, DPP-4is, and placebo. J Clin Endocrinol Metab. Acarbose and DPP-4is were reported to have a higher efficacy in Eastern patients than in the Western counterparts (23, 33, 34). Acarbose can lower HbA1C level by 0.51% and can reduce the incidence of type 2 diabetes in prediabetic patients by 36%. (2016) 18:78493. doi: 10.1136/bmj.b2535, 11. (2019) 321:6979. (B) Flowchart of the 48 studies included in network meta-analysis. A total of 11 different DPP-4is were included in our NMA. Weight beneficial treatments for type 2 diabetes. Acarbose had more withdrawal, gastrointestinal, and overall adverse events than DPP-4is (p < 0.05), but the differences disappeared after longer treatment (p > 0.05). Younk LM, Lamos EM, Davis SN. After 6 months, metabolic parameters including body weight, WC, FBS, TG, TC, HDL, and LDL, an inflammatory marker of CRP, and cardiovascular markers including FMD, IMT, EFT were assessed and recorded through blood tests. After 26 weeks, completed by 37 subjects in the acarbose group and by 38 subjects in the placebo group, a . [3] It is estimated that 2025% of the world adult population suffers from MetS disorders. BMJ. Stat Med. Animal studies with acarbose have consistently shown that Acarbose has a body fat-lowering action. Cardiovascular indexes including flow-mediated dilation (FMD), intima-media thickness (IMT), epicardial fat thickness (EFT), and C-reactive protein (CRP) were measured at baseline and 6 months after the treatment and compared between the two groups. Checking consistency in mixed treatment comparison meta-analysis. Cai X, Han X, Luo Y, Ji L. Efficacy of dipeptidyl-peptidase-4 inhibitors and impact on -cell function in Asian and Caucasian type 2 diabetes mellitus patients: a meta-analysis. Our NMA involved 48 monotherapy trials, whose comparators included acarbose (300 mg/day), DPP-4is, metformin (1,500 mg/day), pioglitazone (45 mg/day), and placebo. Careers, Unable to load your collection due to an error. We divided the 13 head-to-head studies into three subgroups according to the treatments: monotherapy (n = 3), co-therapy with oral anti-diabetic drugs (OAD) (n = 6), and co-therapy with insulin (n = 4). INDICATIONS AND USAGE Acarbose Tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. doi: 10.1001/jama.2010.405, 8. Firstly, we did not retrieve the cardiovascular outcomes (CVOs). Individualize treatment and adjust target blood glucose and HbA 1c concentrations based on patient's understanding and adherence to the treatment regimen, the risk of severe hypoglycemia, and other factors that may increase risk or decrease benefit (e.g., very young or old age, comorbid conditions, other diseases that materially shorten life . FZ and NT obtained funding for the study and designed it. However, due to the inconsistency in the FPG results between the direct and indirect comparisons, these findings could not be extrapolated, and they need to be further studied. Further studies are thus needed to determine whether the hypoglycemic effects are maintained over the years, especially among the patients with a long disease progression. Precose is available in generic form. The results of the funnel plots and Egger's tests revealed that no potential publication bias existed across the included studies (Figure S1). (The AE data collected across all the 48 studies are shown in Table S5). CRP is produced by mature adipocytes in adipose tissue and may contribute to the elevated circulating plasma CRP concentrations present in obese patients and people with the MetS. (2015) 100:36370. While there was no significant difference in mean reduction FMD between two groups (0.02 0.05 vs 0.01 0.04; P value = 0.371) [Table 3]. The previous study revealed that acarbose decreases appetite and opposes unwanted fat storage by reducing food intake. Hypoglycemia may occur, more commonly when used in combination with insulin or a sulfonylurea; patients should be instructed to treat hypoglycemia with oral glucose (dextrose) as sucrose (cane sugar) is not expected to correct hypoglycemia due to this drug inhibiting breakdown to glucose and fructose. The 2hPG reduction in DPP-4is was superior to that in acarbose in the monotherapy group (p < 0.05) (Figure 2A). 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