Nateglinide and acarbose are comparably effective reducers of postprandial glycemic excursions in chinese antihyperglycemic agent-naive subjects with type 2 diabetes

Abstract

Background: Recent studies have identified postprandial glycemic excursions as risk factors for diabetes complications. This study aimed to compare the effects of nateglinide and acarbose treatments on postprandial glycemic excursions in Chinese subjects with type 2 diabetes.

Subjects and methods: This was a multicenter, open-label, randomized, active-controlled, parallel-group study. One hundred three antihyperglycemic agent-naive subjects with type 2 diabetes (hemoglobin A1c range, 6.5-9.0%) were prospectively recruited from four hospitals in China. The intervention was nateglinide (120 mg three times a day) or acarbose (50 mg three times a day) therapy for 2 weeks. A continuous glucose monitoring system was used to calculate the incremental area under the curve of postprandial blood glucose (AUCpp), the incremental glucose peak (IGP), mean amplitude of glycemic excursions, SD of blood glucose, the mean of daily differences, and 24-h mean blood glucose (MBG). Subjects' serum glycated albumin and the plasma insulin levels were also analyzed.

Results: Both agents caused significant reductions on AUCpp and IGP. Similarly, both treatment groups showed significant improvements in the intra- and interday glycemic excursions, as well as the 24-h MBG and serum glycated albumin compared with baseline (P<0.001). However, neither of the agents produced a significantly better effect (P>0.05). Moreover, the nateglinide-treated group had significantly increased insulin levels at 30 min and at 120 min after a standard meal compared with baseline, whereas the acarbose-treated group decreased. No serious adverse events occurred in either group. The rates of hypoglycemic episodes were comparable in the two groups, and no severe hypoglycemic episode occurred in either group.

Conclusions: Nateglinide and acarbose were comparably effective in reducing postprandial glycemic excursions in antihyperglycemic agent-naive Chinese patients with type 2 diabetes, possibly through different pathophysiological mechanisms.

Trial registration: ClinicalTrials.gov NCT01030952.

FIG. 1.

Study design and clinic visit schedule. CGMS, continuous glucose monitoring system; TID, three times a day.

FIG. 2.

Average continuous glucose monitoring tracings from baseline (red curve) and after 2 weeks of treatment (green curve) with either (A) nateglinide or (B) acarbose.

FIG. 3.

Comparison of mean changes in (A) postprandial blood glycemic excursions (incremental area under the curve of postprandial blood glucose [AUCpp]) and (B) serum glycated albumin (GA) in the nateglinide and acarbose groups. Data are mean±SD values. *P<0.001 versus baseline.

FIG. 4.

Change in insulin levels from baseline in the nateglinide and acarbose groups. The nateglinide-treated group had a significantly larger change in insulin levels than the acarbose-treated group (P<0.001).