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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