Abstract

BackgroundTo compare the efficacy of glycemic control and insulin secretion of alpha glucosidase inhibitors (AGI) on type 2 diabetes patients between Asian and Caucasian.Methodology/Principal FindingsThe MEDLINE®, EMBASE®, CENTRAL were searched and qualified studies in Asian and Caucasian population comparing AGI treatment with placebo or other oral anti-diabetic drugs in type 2 diabetic patients were included. Totally 58 qualified studies were included. When AGI treatment was compared with placebo, a significant difference in HbA1c decline from baseline favoring AGI treatment was found in Asian (weighted mean difference (WMD), −0.50%; 95% CI, −0.66% to −0.34%) and in Caucasian a significant difference in HbA1c decline favoring AGI treatment was also found (WMD, −0.68%; 95% CI, −0.76% to −0.60%). In Asian, fasting plasma glucose was reduced with AGI treatment compared with placebo (WMD, −0.53 mmol/L; 95% CI, −0.91 to −0.14 mmol/L) and in Caucasian there was also a significant difference in FPG changes favoring AGI therapy (WMD, −0.88 mmol/L; 95% CI, −1.00 to −0.77 mmol/L). Studies in Asian showed a significant difference in fasting insulin changes favoring AGI treatment (WMD, −0.78 uU/ml; 95% CI, −0.96 to −0.59 uU/ml). While in Caucasian fasting insulin was decreased without significance with AGI treatment (WMD-1.24 uU/ml; 95% CI, −2.51 to 0.04 uU/ml). Body weight was decreased with AGI treatment in Asian (WMD, −1.00 kg; 95% CI, −1.69 to −0.31 kg) and was also decreased with AGI treatment in Caucasian (WMD, −0.73 kg; 95% CI, −1.13 to −0.33 kg).Conclusions/SignificanceAccording to results from this meta-analysis, the efficacy in glucose lowering, body weight reduction and insulin secretion decreasing of AGI treatment in Asian were comparable with those in Caucasian.

Highlights

  • In the treatment of type 2 diabetes, alpha-glucosidase inhibitors (AGIs; including acarbose, miglitol, voglibose) were recommend by guidelines for glucose control in type 2 diabetes

  • The analysis suggested that treatment with AGIs lead to comparable changes of HbA1c and body weight in type 2 diabetes patients in Asian and Caucasian population when compared with placebo and other active oral hypoglycemic agents

  • We observed a comparable change of insulin level between Asian and Caucasian population associated with AGIs treatment

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Summary

Introduction

In the treatment of type 2 diabetes, alpha-glucosidase inhibitors (AGIs; including acarbose, miglitol, voglibose) were recommend by guidelines for glucose control in type 2 diabetes. It was postulated that due to its mode of action, AGIs might be more efficacious in Asian population following an eastern diet with higher carbohydrate content than Caucasian population following a western diet [4,5]. This is a reasonable assumption, it was not evidence based. There are some systemic reviews or meta-analysis evaluating the efficacy and safety of alphaglucosidase inhibitors mainly in Caucasians [6,7]. To compare the efficacy of glycemic control and insulin secretion of alpha glucosidase inhibitors (AGI) on type 2 diabetes patients between Asian and Caucasian

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