Abstract
BackgroundThe data of MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment) trial demonstrated that acarbose and metformin have similar efficacy as initial therapy for hemoglobin A1c (HbA1c) reduction in Chinese patients with newly diagnosed type 2 diabetes. We investigated whether the therapeutic efficacy was diversified under different body mass index (BMI) status.MethodsAll 784 subjects were divided into normal-weight group (BMI<24 kg/m2), overweight group (BMI 24–28 kg/m2) and obese group (BMI≥28 kg/m2). Patients were assigned to 48 weeks of therapy with acarbose or metformin, respectively. The clinical trial registry number was ChiCTR-TRC-08000231.ResultsThe reduction of HbA1c levels and the proportion of patients with HbA1c of 6.5% or less were similar in the three groups after acarbose and metformin treatment. In overweight group, fasting blood glucose (FBG) after metformin treatment showed greater decline compared to acarbose group at 48 weeks [−1.73 (−1.99 to −1.46) vs. −1.37 (−1.61 to −1.12), P<0.05), however the decrease of 2 h post-challenge blood glucose (PBG) after acarbose treatment at 48 weeks was bigger compared to metformin group [−3.34 (−3.83 to−2.84) vs. −2.35 (−2.85 to −1.85), P<0.01 ]. Both acarbose and metformin treatment resulted in a significant decrease in waist circumference, hip circumference, weight and BMI in the three groups (all P<0.05).ConclusionAcarbose and metformin decreased HbA1c levels similarly regardless of BMI status of Chinese type 2 diabetic patients. Acarbose and metformin resulted in a significant and modest improvement of anthropometric parametres in different BMI status. Thus, acarbose treatment may contribute a similar effect on plasma glucose control compared to metformin, even in obesity patients.Trial RegistrationChiCTR.org ChiCTR-TRC-08000231
Highlights
Type 2 diabetes is a metabolic disease with high mortality and morbidity [1]
A significant trend was presented for age, waist circumference, hip circumference, body weight, diastolic blood pressure, high-density lipoprotein cholesterol (HDL-C), TG, Non-HDL-C, post-challenge blood glucose (PBG), fasting serum insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of b cell function (HOMA-b), and the proportion of patients with optimal levels of low-density lipoprotein cholesterol (LDL-C) and nonHDL-C among all groups
The significant reductions in fasting blood glucose (FBG), PBG, and FINS were observed in the three groups with acarbose or metformin treatment for 24 weeks and 48 weeks
Summary
Type 2 diabetes is a metabolic disease with high mortality and morbidity [1]. For treating diabetes, numerous novel glucoselowering agents have been developed [2], which are more expensive and lack long-term follow-up safety data. The result of the MARCH trial demonstrates that acarbose and metformin have similar efficacy on lowering HbA1c as initial therapy for newly diagnosed type 2 diabetic patients in China [6]. It is unclear whether the above mentioned therapeutic efficacy was diversified under the different BMI status, such as in normal weight, overweight and obese patients. We assessed the therapeutic effect of acarbose and metformin in newly diagnosed type 2 diabetic patients with different BMI status by reanalyzing data from the MARCH trial. We investigated whether the therapeutic efficacy was diversified under different body mass index (BMI) status
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