Effect of acarbose on glycemic control and lipid metabolism in patients with non—insulin-dependent diabetes mellitus

Abstract

Acarbose was administered orally at a dosage of 300 mg/d for 4 months to 20 patients (8 men and 12 women) with non—insulin-dependent diabetes mellitus to assess its effects on glycermic control and lipid and lipoprotein metabolism and to determine whether its actions were influenced by the degree of glycemic control. No significant changes in body weight or fasting plasma glucose levels were reported, but levels of glycated hemoglobin A 1c (Hb A 1c) decreased significantly from 9.1 ± 1.8% (mean ± SD) to 8.2 ± 1.6%. In addition, no significant changes in plasma insulin levels or in insulin resistance were reported. Triglyceride (TG) levels decreased significantly from 175.7 ± 140.2 mg/dL to 127.6 ± 94.1 mg/dL. During the 75-g oral glucose tolerance test, a significant decrease in ∑TG levels (sum of TG levels at baseline and at 30, 60, and 120 minutes after glucose load) from 654.3 ± 475.1 mg/dL to 498.0 ± 356.0 mg/dL was reported, and a significant decrease in ∑free fatty acids from 1.62 ± 0.48 mEq/L to 1.33 ± 0.47 mEq/L was noted. In addition, significant changes were noted in levels of apolipoprotein B (from 122.5 ± 43.0 mg/dL to 105.7 ± 31.4 mg/dL) and in remnant-like particles of TG (from 54.3 ± 67.3 mg/dL to 25.5 ± 27.8 mg/dL). The patients were classified into two groups for comparison: patients with good glycemic control (n = 10; Hb A 1c, 7.8 ± 1.0%) and patients with poor glycemic control (n = 10; Hb A 1c, 10.4 ± 1.4%). The improvement in the levels of Hb A 1c was greater in the latter group, but there was no clear improvement in insulin resistance in either group. Improvement in lipid metabolism was noted in both groups, but no significant differences between the two groups with respect to the degree of improvement were noted. These results showed that acarbose not only improved the levels of Hb A 1c but also improved TG-rich lipoprotein metabolism. Although the improvement in Hb A 1c levels was greater in the patients with poor glycemic control, the effect of acarbose on lipoprotein metabolism was unrelated to the degree of glycemic control.