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Alpha-glucosidase inhibitors for type 2 diabetes mellitus

Evidence Summaries

Level of Evidence = A

 Alpha-glucosidase inhibitors have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. It is unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes.

A Cochrane review 1 included 41 studies with a total of 8130 subjects. Acarbose was investigated in 30 trials, miglitol in seven, voglibose in one, and three trials compared different alpha-glucosidase inhibitors. Study duration was 24 weeks in most cases and only two studies lasted amply longer than one year. We found only few data on mortality, morbidity and quality of life. Acarbose had a clear effect on glycemic control compared to placebo: glycated haemoglobin -0.8% (95% confidence interval -0.9 to -0.7), fasting blood glucose -1.1 mmol/L (95% confidence interval -1.4 to -0.9), post-load blood glucose -2.3 mmol/L (95% confidence interval -2.7 to -1.9). The effect on glycated haemoglobin by acarbose was not dose-dependent. We found a decreasing effect on post-load insulin and no clinically relevant effects on lipids or body weight. Adverse effects were mostly of gastro-intestinal origin and dose dependent. Compared to sulphonylurea, acarbose decreased fasting and post-load insulin levels by -24.8 pmol/L (95% confidence interval -43.3 to -6.3) and -133.2 pmol/L (95% confidence interval -184.5 to -81.8) respectively and acarbose caused more adverse effects.

References

1. Van de Laar FA, Lucassen PL, Akkermans RP, Van de Lisdonk EH, Rutten GE, Van Weel C. Alpha-glucosidase inhibitors for type 2 diabetes mellitus. Cochrane Database Syst Rev 2005 Apr 18;(2):CD003639.  [PMID:15846673]


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Citation

"Alpha-glucosidase Inhibitors for Type 2 Diabetes Mellitus." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/453532/all/Alpha_glucosidase_inhibitors_for_type_2_diabetes_mellitus.
Alpha-glucosidase inhibitors for type 2 diabetes mellitus. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/453532/all/Alpha_glucosidase_inhibitors_for_type_2_diabetes_mellitus. Accessed August 20, 2019.
Alpha-glucosidase inhibitors for type 2 diabetes mellitus. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/453532/all/Alpha_glucosidase_inhibitors_for_type_2_diabetes_mellitus
Alpha-glucosidase Inhibitors for Type 2 Diabetes Mellitus [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2019 August 20]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/453532/all/Alpha_glucosidase_inhibitors_for_type_2_diabetes_mellitus.
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TY - ELEC T1 - Alpha-glucosidase inhibitors for type 2 diabetes mellitus ID - 453532 BT - Evidence-Based Medicine Guidelines UR - https://evidence.unboundmedicine.com/evidence/view/EBMG/453532/all/Alpha_glucosidase_inhibitors_for_type_2_diabetes_mellitus PB - Duodecim Medical Publications Limited DB - Evidence Central DP - Unbound Medicine ER -