Effect of acarbose on glycemic control, serum lipids and lipoproteins in type 2 diabetes.
OBJECTIVE
To assess the efficacy of acarbose monotherapy during 12-weeks treatment on the fasting glycemic level, lipid and lipoproteins profiles, in patients with type 2 diabetes mellitus.


SETTING
Type 2 diabetics were selected from out patient department of Baqai Diabetes and Endocrine Centre, and one other diabetic clinic of Karachi, during 1996-97.


DESIGN
A prospective intervention trial, and a 10 days screening period with a follow-up of 12 weeks.


METHODS
Forty-four patients (36 men and 8 women, mean age 55.09 +/- 1.72 years) were included of whom 25 (56.81%) patients were previously treated with diet alone, 11(25%) with diet and glibenclamide, 5(11.36%) with diet and gliclazide, and 3(6.81%) with diet and chlorpropamide, more than at least 3 months known duration of diagnosed type 2 diabetes, body mass index (BMI) 23.69 +/- 0.49 kg/m2, were insufficiently controlled on diet alone, or diet plus sulfonylureas, were studied. The dosage of acarbose was started with 50 mg t.i.d with each meal, if necessary, was titrated upward on subsequent visits to 100 mg t.i.d with each meal, based on tolerability and efficacy. Fasting blood glucose, lipid and lipoprotein profiles were determined at the baseline and at the end of the study.


RESULTS
Acarbose treatment was associated with significant reduction in fasting blood glucose from (mean +/- SE) 173.89 +/- 3.89 mg/dl at day 0 to 161.29 +/- 3.41 mg/dl at day 90 (P < 0.01). The serum total triglyceride level was (mean +/- SE) 188.85 +/- 5.91 mg/dl at entry, and was also significantly decreased to 158.57 +/- 4.48 mg/dl at day 90, this reduction was found statistically significant (P < 0.01). Whereas very-low density lipoprotein cholesterol reduced significantly from 33.08 +/- 1.09 mg/dl at day 0 to 31.02 +/- 0.95 mg/dl at day 90 (P < 0.01). Acarbose had no significant effect on serum total cholesterol, low-density lipoprotein cholesterol, and High-density lipoprotein cholesterol concentrations. Almost, all adverse experiences, as reported by patients on acarbose, were related to the digestive system and included diarrhea, flatulence, bloating and nausea. Most symptoms were of mild to moderate intensity and tended to improve with time. Overall, acarbose was well tolerated and the adverse experience profile was clinically acceptable.


CONCLUSION
In type 2 diabetic patients, acarbose as monotherapy for 12 weeks resulted in beneficial effects on glycemic control, fasting blood glucose, mean serum total triglyceride and very-low density lipoprotein cholesterol decreased significantly. Perhaps attainment of normoglycemia on a long-term basis would result in more normal lipid and lipoprotein levels. Furthermore use of acarbose can be considered as a useful alternative in such type 2 patients, if they are difficult to control with diet alone or diet plus sulfonylureas (JPMA 50:152, 2000).