The preventive effect of Acarbose and Metformin on the progression to diabetes mellitus in the IGT population: a 3-year multicenter prospective study.
Chin J Endocrinol Metab, June 2001, Vol 17, No. 3 p131-6
Yang Wenying, Lin Lixiang, Qi Jinwu, Yu Zhiqing, Pei Haicheng, He Guofeng, Yang Zaojun, Wang Fan, Li Guangwei, Pan Xiaoren Department of Endocrinology, China-Japan Friendship Hospital, Beijing
ABSTRACT: Objective: To assess the effect of pharmacological and non-pharmacological interventions on Chinese subjects with impaired glucose tolerance (IGT). Methods: In this 3-year prospective study, 321 subjects aged above 25 years with IGT were included. IGT was diagnosed according to the 1985 WHO criteria by utilizing a 75 g oral glucose tolerance test (OGTT). The subjects were divided into control (C), diet plus exercise (D+E), Acarbose (Glucobay, A) and Metformin (M) groups. The subjects in group D+E underwent an individually designed diet and exercise program, with yearly visits for education and enforcement of the diet and exercise program. Group C only received conventional education on diabetes prevention. The two pharmacological groups received orally either Acarbose (50mg, t.i.d) or Metformin (0.25g, t.i.d). OGTT, weight, height, blood pressure, and lipids were measured yearly during the follow-up. The t-test, Chi-square test and proportional hazard regression analysis were used to analyze the risk reduction for the development of diabetes in each group. Results: The baseline data of 4 groups had no statistical differences. By the end of the study, both the fasting plasma glucose (FPG) and the 2 hour postprandial plasma glucose (2 hPG) in group C were elevated (FPG from 6.02 mmol/L to 6.59 mmol/L, 2 hPG from 8.83 mmol/L to 9.13 mmol/L).The annual diabetes incidence was 11.6%. The corresponding changes in group D+E were FPG from 6.11 mmol/L to 6.21 mmol/L, 2 hPG from 9.28 mmol/L to 8.98 mmol/L, with 8.2% as annual incidence of diabetes. In contrast, both the FPG and the 2 hPG significantly decreased in group A (FPG from 6.03 mmol/L to 5.47 mmol/L, 2 hPG from 8.34 mmol/L to 7.21 mmol/L). Similar results were found in group M (FPB from 6.01 mmol/L to 5.85 mmol/ L, 2 hPG from 9.05 mmol/L to 7.92 mmol/L). The annual diabetes incidence decreased to 2.0% in group A, and 4.1% in group M. Proportional hazard regression analysis showed that the annual diabetes incidence was positively correlated with the baseline 2 hPG and body mass index (OR = 1.33, P=0.006 and OR=1.11, P=0.008, respectively), while it was negatively correlated with group C and group M (OR=0.12, P=0.0001 and OR=0.23, P=0.0002, respectively). Conclusion: The natural diabetes incidence is 11.6% in the IGT population, and 8.2% in the population with conventional diet and exercise interventions; between them there is no significant difference. The pharmacological interventions with Acarbose or Metformin significantly decrease the diabetes conversion rate in the IGT population.