Cardiovascular benefits and safety profile of acarbose therapy in prediabetes and established type 2 diabetes

Abstract

Dysglycaemic disease is one of the most important health issues facing the world in the 21st century. Patients with type 2 diabetes and individuals with prediabetes are at risk of developing macrovascular and microvascular complications. Long-term management strategies are therefore required that are effective at controlling dysglycaemia, well tolerated and, ideally, offer additional cardiovascular disease (CVD) risk-reduction benefits. The efficacy, safety and tolerability of the alpha-glucosidase inhibitor acarbose have been well-established in a wide range of patient populations in both clinical and community trials. In addition, acarbose has been shown to reduce cardiovascular complications in type 2 diabetes and prevent hypertension and CVD in individuals with impaired glucose tolerance (IGT). Acarbose has a very good safety profile and, owing to its straightforward, non-systemic mode of action, avoids most adverse events. The most common side-effects of acarbose are mild-to-moderate gastrointestinal complaints that subside as treatment continues. They can be minimised through the use of an appropriate stepwise dosing regimen and careful choice of diet. Acarbose is therefore a valuable option for the management of type 2 diabetes and, as the only oral antidiabetes agent approved for the treatment of prediabetes, can help to improve clinical management across the dysglycaemic disease continuum.

Figure 1

Acarbose delays the absorption of carbohydrates from the gut.

Figure 2

Acarbose reduces the risk of myocardial infarction in patients with type 2 diabetes. [21]

Figure 3

The role of postprandial hyperglycaemia in the development of type 2 diabetes and CVD.

Figure 4

Mean systolic and diastolic blood pressure in patients with hypertension and type 2 diabetes treated with acarbose or glibenclamide for 6 months. Adapted with permission from Rosenthal & Mausersberger. [57]

Figure 5

Numbers of patients with intestinal side-effects receiving placebo (n = 55), 100 mg acarbose (n = 54), and 100 mg acarbose with stepwise dosing (n = 55) during 12-week treatment. Adapted with permission from May. [72]