Treatment of impaired glucose tolerance with acarbose and its effect on intima-media thickness: a substudy of the STOP-NIDDM trial (study to prevent non-insulin-dependent diabetes mellitus)

Abstract

Objective: To discuss the influence of glucose excursions on intima-media thickness (IMT) and the potential benefits of treatment to reduce or reverse its effects on cardiovascular risk.

Methods: The findings in pertinent reported studies are reviewed, and the efficacy of various interventions for management of impaired glucose tolerance and type 2 diabetes in slowing the progression of IMT is analyzed.

Results: Considerable evidence from published epidemiologic studies provides compelling data regarding the association between postprandial and postchallenge glycemic excursions and cardiovascular risk. IMT has been shown to be a good surrogate marker for symptomatic and coronary atherosclerosis. Acarbose treatment in patients with impaired glucose tolerance has been shown to diminish the progression of IMT in comparison with placebo. In a study of repaglinide or glyburide therapy in patients with type 2 diabetes, a reduction in IMT was noted in the repaglinide group but not in the glyburide group at 1-year follow-up.

Conclusion: Measurement of IMT allows direct observation of vascular damage attributable to postprandial and postchallenge hyperglycemia. It also provides a means for direct assessment of the effect of medications used for the control of glucose excursions.