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Cited by 690Diabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Research

α-Glucosidase Inhibitors for Patients With Type 2 Diabetes

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van de Laar, Floris A., Lucassen, Peter L., Akkermans, Reinier P., van de Lisdonk, Eloy H., Rutten, Guy E., van Weel, Chris·2005·Diabetes Care
DOI 10.2337/diacare.28.1.154
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Abstract

OBJECTIVE—To review the effects of monotherapy with α-glucosidase inhibitors (AGIs) for patients with type 2 diabetes, with respect to mortality, morbidity, glycemic control, insulin levels, plasma lipids, body weight, and side effects. RESEARCH DESIGN AND METHODS—We systematically searched the Cochrane Central register of Controlled Trials, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, and reference lists, and we contacted experts and manufacturers. Inclusion criteria were randomized controlled trials of at least 12 weeks’ duration, AGI monotherapy compared with any intervention, and one of the following outcome measures: mortality, morbidity, GHb, blood glucose, lipids, insulin levels, body weight, or side effects. Two independent reviewers assessed all abstracts, extracted all data, and assessed quality. We contacted all authors for data clarification. Continuous data were expressed as weighted mean differences and analyzed with a random-effects model. Possible influences of study characteristics and quality were assessed in sensitivity and meta-regression analyses. RESULTS—Forty-one studies were included in the review (30 acarbose, 7 miglitol, 1 voglibose, and 3 combined), and heterogeneity was limited. We found no evidence for an effect on mortality or morbidity. Compared with placebo, AGIs had a beneficial effect on GHb (acarbose −0.77%; miglitol −0.68%), fasting and postload blood glucose and postload insulin. With acarbose dosages higher than 50 mg t.i.d., the effect on GHb was the same, but the occurrence of side effects increased. Acarbose decreased the BMI by 0.17 kg/m2 (95% CI 0.08–0.26). None of the AGIs had an effect on plasma lipids. Compared with sulfonylurea, AGIs seemed inferior with respect to glycemic control, but they reduced fasting and postload insulin levels. For comparisons with other agents, little data were available. CONCLUSIONS—We found no evidence for an effect on mortality or morbidity. AGIs have clear beneficial effects on glycemic control and postload insulin levels but not on plasma lipids. There is no need for dosages higher than 50 mg acarbose t.i.d.

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  • A systematic review disapproves of acarbose dosages higher than 50 mg three times a day, as there is no better effect on glycated hemoglobin.

    “a systematic review disapproves of acarbose dosages higher than 50 mg (three times a day), as there is no better effects on glycated hemoglobin (191).”

    From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [191]

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Research works printed but not linked: 3

  1. McIntosh A, Hutchinson A, Home PD, Brown F, Bruce A, Damerell A, Davis R, Field R, Frost G. Marshall S, Roddick J, Tesfaye S, Withers H, Suckling R, Smith S, Griffin S, Kaltenthaler E, Peters J, Feder G: Clinical Guidelines and Evidence Review for Type 2 Diabetes: Management of Blood Glu- cose. Sheffield, U.K., School of Health and Related Research, University of Sheffield, 2001
  2. Scott LJ, Spencer CM: Miglitol: a review of its therapeutic potential in type 2 diabetes mellitus. Drugs 59:521-549, 2000
  3. Chiches- ter, U.K., Wiley, 2004

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Authors
van de Laar, F. A., Lucassen, P. L., Akkermans, R. P., van de Lisdonk, E. H., Rutten, G. E., & van Weel, C.
Affiliations
  • Department of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
  • Radboud University Medical Center (NL)
  • Julius Centre for Health Sciences and Primary Care, Utrecht, the Netherlands
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2005-01-01
Volume
28
Issue
1
Pages
154-163
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.28.1.154
OpenAlex
W2156215703
Cited by
690
References
56
Citations by year
2026: 28 · 2025: 26 · 2024: 35 · 2023: 31 · 2022: 43 · 2021: 47 · 2020: 58 · 2019: 34 · 2018: 32 · 2017: 40 · 2016: 37 · 2015: 48 · 2014: 34 · 2013: 34 · 2012: 27
FWCI
1.94
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
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 › Diabetes Management and Research
Keywords
alpha-glucosidase inhibitors, type 2 diabetes, acarbose, miglitol, voglibose, glycemic control, HbA1c, postprandial blood glucose, insulin levels, body weight, plasma lipids, mortality, morbidity, adverse drug reactions, monotherapy, dosage
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 2, Enzyme Inhibitors, Humans, Databases, Factual, Glycoside Hydrolase Inhibitors

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