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Cited by 57Diabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsNatural Antidiabetic Agents Studies

Alpha-glucosidase inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus

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Moelands, Suzanne VL, Lucassen, Peter LBJ, Akkermans, Reinier P, De Grauw, Wim JC, Van de Laar, Floris A·2018·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd005061.pub3PMC PMC6517235
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Abstract

BACKGROUND: Alpha-glucosidase inhibitors (AGI) reduce blood glucose levels and may thus prevent or delay type 2 diabetes mellitus (T2DM) and its associated complications in people at risk of developing of T2DM. OBJECTIVES: To assess the effects of AGI in people with impaired glucose tolerance (IGT), impaired fasting blood glucose (IFG), moderately elevated glycosylated haemoglobin A1c (HbA1c) or any combination of these. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of systematic reviews, articles and health technology assessment reports. The date of the last search of all databases was December 2017. SELECTION CRITERIA: We included randomised controlled trials (RCTs), with a duration of one year or more, comparing AGI with any pharmacological glucose-lowering intervention, behaviour-changing intervention, placebo or no intervention in people with IFG, IGT, moderately elevated HbA1c or combinations of these. DATA COLLECTION AND ANALYSIS: Two review authors read all abstracts and full-text articles or records, assessed quality and extracted outcome data independently. One review author extracted data, which were checked by a second review author. We resolved discrepancies by consensus or involvement of a third review author. For meta-analyses we used a random-effects model with assessment of risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs) for effect estimates. We assessed the overall quality of the evidence by using the GRADE instrument. MAIN RESULTS: For this update of the Cochrane Review (first published 2006, Issue 4) we included 10 RCTs (11,814 participants), eight investigating acarbose and two investigating voglibose, that included people with IGT or people "at increased risk for diabetes". The trial duration ranged from one to six years. Most trials compared AGI with placebo (N = 4) or no intervention (N = 4).Acarbose reduced the incidence of T2DM compared to placebo: 670 out of 4014 people (16.7%) in the acarbose groups developed T2DM, compared to 812 out of 3994 people (20.3%) in the placebo groups (RR 0.82, 95% CI 0.75 to 0.89; P < 0.0001; 3 trials; 8008 participants; moderate-certainty evidence). One trial including participants with coronary heart disease and IGT contributed 64% of cases for this outcome. Acarbose reduced the risk of T2DM compared to no intervention: 7 out 75 people (9.3%) in the acarbose groups developed T2DM, compared to 18 out of 65 people (27.7%) in the no-intervention groups (RR 0.31, 95% CI 0.14 to 0.69; P = 0.004; 2 trials; 140 participants; very low-certainty evidence).Acarbose compared to placebo did not reduce or increase the risk of all-cause mortality (RR 0.98, 95% CI 0.82 to 1.18; P = 0.86; 3 trials; 8069 participants; very low-certainty evidence), cardiovascular mortality (RR 0.88; 95% CI 0.71 to 1.10; P = 0.26; 3 trials; 8069 participants; very low-certainty evidence), serious adverse events (RR 1.12, 95% CI 0.97 to 1.29; P = 0.13; 2 trials; 6625 participants; low-certainty evidence), non-fatal stroke (RR 0.50, 95% CI 0.09 to 2.74; P = 0.43; 1 trial; 1368 participants; very low-certainty evidence) or congestive heart failure (RR of 0.87; 95% CI 0.63 to 1.12; P = 0.40; 2 trials; 7890 participants; low-certainty evidence). Acarbose compared to placebo reduced non-fatal myocardial infarction: one out of 742 participants (0.1%) in the acarbose groups had a non-fatal myocardial infarction compared to 15 out of 744 participants (2%) in the placebo groups (RR 0.10, 95% CI 0.02 to 0.53; P = 0.007; 2 trials; 1486 participants; very low-certainty evidence). Acarbose treatment showed an increased risk of non-serious adverse events (mainly gastro-intestinal events), compared to placebo: 751 of 775 people (96.9%) in the acarbose groups experienced an event, compared to 723 of 775 people (93.3%) in the placebo groups (RR 1.04; 95% CI 1.01 to 1.06; P = 0.0008; 2 trials; 1550 participants). Acarbose compared to no intervention showed no advantage or disadvantage for any of these outcome measures (very low-certainty evidence).One trial each compared voglibose with placebo (1780 participants) or diet and exercise (870 participants). Voglibose compared to placebo reduced the incidence of T2DM: 50 out of 897 participants (5.6%) developed T2DM, compared to 106 out of 881 participants (12%) in the placebo group (RR 0.46, 95% CI 0.34 to 0.64; P < 0.0001; 1 trial; 1778 participants; low-certainty evidence). For all other reported outcome measures there were no clear differences between voglibose and comparator groups. One trial with 90 participants compared acarbose with diet and exercise and another trial with 98 participants reported data on acarbose versus metformin. There were no clear differences for any outcome measure between these two acarbose interventions and the asso

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  • There is strong evidence that oral glucose-lowering medications approved for diabetes reduce progression from prediabetes to diabetes.

    “There is strong evidence that oral glucose-lowering medications approved for DM reduce the progression of prediabetes to DM.888–896”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [889]

    The Incidence of T2DM section reports that acarbose reduced or delayed diabetes diagnoses compared with placebo, based on moderate-certainty evidence; it rates the evidence for voglibose as low certainty. The Authors’ Conclusions limit the finding to alpha-glucosidase inhibitors and say it is unclear whether they prevent the underlying cause. This does not support strong evidence for oral glucose-lowering medications as a whole. (LLM, conf=0.89)

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Research works printed but not linked: 4

  1. Sabes R. Cost-effectiveness analysis of acarbose in the treatment of patients with impaired glucose tolerance. Gaceta Sanitaria / S.E.S.P.A.S 2004;18(6):431-9.
  2. Quilici S, Chancellor J, Maclaine G, McGuire A, Andersson D, Chiasson JL. Cost-effectiveness of acarbose for the management of impaired glucose tolerance in Sweden. International Journal of Clinical Practice 2005;59(10):1143-52. RevMan 2014 [Computer program] Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
  3. Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Akl E, et al. on behalf of the Cochrane GRADEing Methods Group and the Cochrane Statistical Methods Group. Chapter 11: Completing 'Summary of findings' tables and grading the confidence in or quality of the evidence. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). Cochrane, 2017. Available from www.training.cochrane.org/handbook.
  4. meta analysis.mp,pt. or review.pt. or search*.tw. 30. 16 and 29 31. 28 or 30 Embase (Ovid SP)

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Authors
Moelands, S. V., Lucassen, P. L., Akkermans, R. P., De Grauw, W. J., & Van de Laar, F. A.
Affiliations
  • Radboud University Nijmegen (NL)
  • Radboud University Nijmegen Medical Center; Department of Primary and Community Care; PO Box 9101 Nijmegen Netherlands 6500 HB
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2018-12-28
Volume
2018
Issue
12
Pages
CD005061-CD005061
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd005061.pub3
PMC
PMC6517235
OpenAlex
W2908088415
Cited by
57
References
103
Citations by year
2026: 5 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 12 · 2021: 7 · 2020: 8 · 2019: 8
FWCI
0.88
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Natural Antidiabetic Agents Studies
Keywords
alpha-glucosidase inhibitors, type 2 diabetes prevention, impaired glucose tolerance, impaired fasting glucose, acarbose, voglibose, glycemic control, diabetes complications
MeSH terms
Blood Glucose, Cause of Death, Diabetes Mellitus, Type 2, Diet, Fasting, Humans, Inositol, Metformin, Prediabetic State, Exercise, Incidence, Randomized Controlled Trials as Topic, Glucose Intolerance, Acarbose, Glycoside Hydrolase Inhibitors

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