Efficacy Of Acarbose And Metformin In Newly Diagnosed Type 2 Diabetes Patients Stratified By Basaline HbA1c Levels

Background Type 2 diabetes mell itus (T2DM) is a complex progressive disease, which with high mortality and disability rate. It is also considered to be one of the most serious health problems in 21 Century. Therefore early intervention and early treatment become more and more important.It is important to have early intensive glycemie control for reducing and preventing the occurrence of various complications of diabetes. The international guidelines recommend strengthening lifestyle changes to control blood glucose to HbAlc<7%, however, many newly diagnosed T2DM patients are overweight or even obese, and it is difficult to achieve good and stable glycemic control with the help of oral antidiabetic drugs. With the progress of T2DM treatment, most antidiabetic drugs have a very good efficacy and safety and patient tolerance is also very good, but the best glycemic control strategy is still in need. Among so many hypoglycemic drugs, how to choose more sutiable one to treat patients is still difficult. In our previous non-inferiority, randomised controlled study, the MARCH (Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment) trial, we showed that acarbose had similar efficacy to metformin and thus was a viable choice for initial therapy in Chinese patients with newly diagnosed T2DM. In a secondary analysis of MARCH study data, we compared the therapeutic effects of acarbose and metformin in normal weight, overweight and obese patients with different body mass index (BMI) status. Results of that study showed that acarbose and metformin decreased HbAlc levels similarly regardless of BMI status, suggesting that acarbose treatment may have similar effects on blood glucose control as metformin treatment. Therefore, our hypothesis is that differences in patients'baseline HbAlc levels may influence the efficacy of antidiabetic drugs and that this could be demonstrated through comparative studies of antidiabetic drugs in different patient groups stratified by baseline HbAlc levels. Objective The aim of the present study was to investigate whether the therapeutic efficacy of acarbose and metformin is correlated with baseline HbAlc levels in Chinese patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods Data for 711 subjects were retrieved from the MARCH (Metformin and Acarbose in Chinese as initial hypoglycemic treatment) trial database and reviewed retrospectively. Patients were grouped according to baseline HbAlc levels (<7%,7%-8%, and>8%) and the results for these three groups were compared between acarbose and metformin treatments. Results Acarbose and metformin treatment significantly improved T2DM associated parameters (weight, fasting plasma glucose [FPG], postprandial glucose [PPG], glucagon-like peptide-1 [GLP-1], HOMA-IR, and total cholesterol)across all HbAlc levels. Acarbose decreased PPG significantly more than metformin, but only in subjects with lower baseline HbAlc (in the<7% and 7%-8%, all P< 0.05). Acarbose decreased triglyceride (TG) levels, and the areas under the curve (AUC) for insulin and glucagon more than metformin at all HbAlc levels (P < 0.05). After 24 weeks treatment, metformin decreased FPG levels significantly more than acarbose for all baseline HbAlc groups (all P< 0.001).Conclusions Acarbose decreased PPG and TG and spared the AUC for insulin more effectively in patients with low-to-moderate baseline HbAlc levels, whereas metformin induced greater reductions in FPG. These results may help guide selection of initial therapy based on baseline HbAlc.