Abstract
BackgroundPostprandial hyperglycemia is believed to affect vascular endothelial function. The aim of our study was to compare the effects of acarbose and nateglinide on postprandial endothelial dysfunction.MethodsWe recruited a total of 30 patients with newly diagnosed type 2 diabetes (19 men and 11 women, age 67.8 ± 7.3 years). Patients were randomly assigned to 3 groups receiving either 300 mg/day acarbose, 270 mg/day nateglinide, or no medication. A cookie test (consisting of 75 g carbohydrate, 25 g butter fat, and 7 g protein for a total of 553 kcal) was performed as dietary tolerance testing. During the cookie test, glucose and insulin levels were determined at 0, 30, 60, and 120 min after load. In addition, endothelial function was assessed by % flow-mediated dilation (FMD) of the brachial artery at 0 and 120 min after cookie load.ResultsPostprandial glucose and insulin levels were similar in the 3 groups. Postprandial endothelial dysfunction was similar in the 3 groups before treatment. After 12 weeks of intervention, postprandial FMD was significantly improved in the acarbose group compared with the control group (6.8 ± 1.3% vs 5.2 ± 1.1%, p = 0.0022). Area under the curve (AUC) for insulin response was significantly increased in the nateglinide and control groups; however, no significant change was observed in the acarbose group.ConclusionsOur results suggest that acarbose improves postprandial endothelial function by improvement of postprandial hyperglycemia, independent of postprandial hyperinsulinemia. Acarbose may thus have more beneficial effects on postprandial endothelial function in patients with type 2 diabetes than nateglinide.
Highlights
Epidemiological studies have revealed that postprandial hyperglycemia is a more powerful predictor of future cardiovascular events than fasting hyperglycemia [1,2]
Characteristics of study subjects before and after treatment Baseline characteristics before treatment including age, sex, body mass index (BMI), lipid parameters, HbA1c, glucose, insulin, HOMA-IR, systolic and diastolic blood pressure, and heart rate were similar among the 3 groups
The Area under the curve (AUC) for glucose levels was similar among the 3 groups (2041.8 ± 236.7 mg/dl×h in the control group, 2234.3 ± 326.7 mg/dl×h in the acarbose group, 2209.0 ± 306.8 mg/dl×h in the nateglinide group)
Summary
Epidemiological studies have revealed that postprandial hyperglycemia is a more powerful predictor of future cardiovascular events than fasting hyperglycemia [1,2]. Endothelial dysfunction is an early marker of atherosclerosis but is strongly associated with risk of future cardiovascular events [3]. Endothelial dysfunction is associated with cardiovascular risk factors such as smoking [4], dyslipidemia [5,6], hypertension [7,8], obesity [9], type 2 diabetes [10], and postprandial hyperglycemia [11]. Postprandial endothelial dysfunction, postprandial hyperglycemia and cardiovascular events are all strongly associated with one another [12,13]. Since the postprandial state occurs during most of the daytime, interventions that aim to reduce postprandial endothelial dysfunction are essential for the prevention of cardiovascular events. Potential agents to target postprandial hyperglycemia in patients with type 2 diabetes include α-glucosidase inhibitors and glinide drugs. The aim of our study was to compare the effects of acarbose and nateglinide on postprandial endothelial dysfunction
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