Acarbose in the treatment of diabetes mellitus
Evidence Summaries Level of Evidence = C
Acarbose may be more effective than placebo as adjunct therapy for patients with poorly controlled NIDDM.
A systematic review 1 including 5 studies with a total of 1083 subjects was abstracted in DARE. Three studies assessed the effect of acarbose treatment on patients on diet alone. Acarbose-treated patients showed a decrease in HbA1c concentration compared to controls, and a decrease in postprandial hyperglycaemia. There was no significant weight change for patients on acarbose or placebo. Two studies assessed the effect of acarbose treatment in patients on diet and antidiabetic medication (tolbutamide, metformin, sulfonylurea or insulin). HbA1c and mean postprandial glucose declined in acarbose-treated patients, but increased for placebo. Side effects (flatulence, meteorism, abdominal pain and diarrhoea) were relatively mild.
Comment: The quality of evidence is downgraded by severe limitations in review methodology. The review fails include information that is crucial to a good quality systematic review (e.g. the criteria used to assess the validity of the primary studies, the methods of data extraction).
1. Campbell LK, White JR, Campbell RK. Acarbose: its role in the treatment of diabetes mellitus. Ann Pharmacother 1996 Nov;30(11):1255-62. [PMID:8913408]
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