Addition of acarbose as effective as insulin after failure of oral antidiabetics

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Last Updated: 2001-07-16 16:46:08 EDT (Reuters Health)

WESTPORT, CT (Reuters Health) – Adding acarbose to a treatment regimen of conventional oral antidiabetic drugs when the original regimen fails is as effective in reducing glycated hemoglobin (HbA1c) as the addition of bedtime insulin, investigators in Hong Kong report.

Dr. Gary T. C. Ko of Alice Ho Miu Ling Nethersole Hospital and associates randomly assigned 30 Chinese patients with type 2 diabetes to bedtime insulin and 27 to acarbose after treatment with sulfonylurea with or without metformin failed to reduce HbA1c below 9.0%.

Acarbose was initiated at 50 mg t.i.d. for 2 weeks, then increased to 100 mg t.i.d., the authors report in the June issue of Clinical Drug Investigations. Insulin was started at six units at night and was adjusted by two to four units 4 weeks later.

At 3 months and 12 months, acarbose and insulin were similar in percentage reduction of HbA1c from baseline. By the final visit, an HbA1c <8.5% was achieved by 33.3% and 46.7% of the two groups, respectively, a nonsignificant difference (p = 0.419).

Both the acarbose and insulin groups also showed significantly improved two-hour blood glucose levels at 3 months, although only in patients treated with insulin did the levels continue to decline through 12 months.

Five patients in the acarbose group discontinued treatment because of flatulence, diarrhea and abdominal colic, and one discontinued due to plasma creatinine concentration above 200 µmol/L. No major hypoglycemic episodes were noted in either group.

Dr. Ko's team concludes that adding acarbose to the treatment regimen "provides a reasonable alternative, at least in the short term, to patients with secondary oral antidiabetic drug failure who are unable or unwilling to use insulin treatment."

Clin Drug Invest 2001;21:401-408.

-Westport Newsroom 203 319 2700

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