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Review
. 2019 Oct 17;18(1):135.
doi: 10.1186/s12933-019-0933-y.

Meta-analysis of the impact of alpha-glucosidase inhibitors on incident diabetes and cardiovascular outcomes

Ruth L Coleman  1 , Charles A B Scott  2 , Zhihui Lang  3 , M Angelyn Bethel  2 , Jaakko Tuomilehto  4   5   6 , Rury R Holman  2
Affiliations
Review

Meta-analysis of the impact of alpha-glucosidase inhibitors on incident diabetes and cardiovascular outcomes

Ruth L Coleman et al. Cardiovasc Diabetol. .

Abstract

Background: Alpha-glucosidase inhibitors (AGIs) have been shown to reduce incident type 2 diabetes but their impact on cardiovascular (CV) disease remains controversial. We sought to identify the overall impact of AGIs with respect to incident type 2 diabetes in individuals with impaired glucose tolerance (IGT), and CV outcomes in those with IGT or type 2 diabetes.

Methods: We used PubMed and SCOPUS to identify randomized controlled trials reporting the incidence of type 2 diabetes and/or CV outcomes that had compared AGIs with placebo in populations with IGT or type 2 diabetes, with or without established CV disease. Eligible studies were required to have ≥ 500 participants and/or ≥ 100 endpoints of interest. Meta-analyses of available trial data were performed using random effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident type 2 diabetes and CV outcomes.

Results: Of ten trials identified, three met our inclusion criteria for incident type 2 diabetes and four were eligible for CV outcomes. The overall HR (95% CI) comparing AGI with placebo for incident type 2 diabetes was 0.77 (0.67-0.88), p < 0.0001, and for CV outcomes was 0.98 (0.89-1.10), p = 0.85. There was little to no heterogeneity between studies, with I2 values of 0.03% (p = 0.43) and 0% (p = 0.79) for the two outcomes respectively.

Conclusions: Allocation of people with IGT to an AGI significantly reduced their risk of incident type 2 diabetes by 23%, whereas in those with IGT or type 2 diabetes the impact on CV outcomes was neutral.

Keywords: Alpha glucosidase inhibitor; Cardiovascular disease; Impaired glucose tolerance; Meta-analysis; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests with respect to the research, authorship, and/or publication of this review. ZL is an employee of Bayer Healthcare, China.

Figures

Fig. 1
Fig. 1
Selection of eligible trials
Fig. 2
Fig. 2
Forest plot of incident diabetes results for each trial and overall effect
Fig. 3
Fig. 3
Forest plot of incident cardiovascular outcome results for each trial and overall effect
See this image and copyright information in PMC

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