Indiana University School of Medicine, Indianapolis, IN, USA.
Diabetes Metab Res Rev. 2013 Oct;29(7):582-91. doi: 10.1002/dmrr.2433.
The anti-diabetic agent acarbose reduces postprandial glucose excursions. We have evaluated the effect of randomized treatment with acarbose on the progression of carotid intima-media thickness (IMT) in early diabetes.
The Early Diabetes Intervention Program was a randomized trial of acarbose versus placebo in 219 participants with early diabetes characterized by glucose values over 11.1 mmol/L 2 h after a 75 g oral glucose load and a mean HbA1c of 6.3%. IMT was measured at baseline and yearly. Follow-up was discontinued if participants progressed to the study glucose endpoints; IMT readings were available for a median of 2 years, with 72 subjects followed for 5 years.
Progressive increases in IMT were seen in both treatment groups, but progression was reduced in participants randomized to acarbose (p = 0.047). In age, sex and smoking-adjusted analyses, IMT progression was associated with greater fasting and oral glucose tolerance test-excursion glucose, fasting insulin, cholesterol and glycated low-density lipoprotein concentrations. IMT progression was reduced with study-related changes in weight, insulin and non-esterified fatty acids; these features were more strongly associated with reduced IMT progression than acarbose treatment. Despite strong associations of baseline glycemia with IMT progression, study-related changes in glucose were not important determinants of IMT progression.
Acarbose can delay progression of carotid intima-media thickness in early diabetes defined by an oral glucose tolerance test. Glucose, weight, insulin and lipids contributed to risk of progression but reductions in glycemia were not major determinants of reduced rate of IMT progression. Vascular benefits of acarbose may be independent of its glycemic effects.
抗糖尿病药物阿卡波糖可降低餐后血糖波动。我们评估了阿卡波糖随机治疗对早期糖尿病患者颈动脉内膜中层厚度（IMT）进展的影响。
早期糖尿病干预计划是一项阿卡波糖与安慰剂的随机对照试验，纳入了 219 名早期糖尿病患者，这些患者的葡萄糖值在口服 75g 葡萄糖负荷后 2 小时超过 11.1mmol/L，平均糖化血红蛋白（HbA1c）为 6.3%。基线和每年测量 IMT。如果参与者达到研究血糖终点，则停止随访；IMT 读数的中位随访时间为 2 年，72 名参与者随访 5 年。
两组患者的 IMT 均呈进行性增加，但阿卡波糖组的进展速度较慢（p=0.047）。在年龄、性别和吸烟调整分析中，IMT 进展与空腹和口服葡萄糖耐量试验（OGTT）血糖、空腹胰岛素、胆固醇和糖化低密度脂蛋白浓度的增加有关。与体重、胰岛素和非酯化脂肪酸的研究相关变化与 IMT 进展减少有关；与阿卡波糖治疗相比，这些特征与 IMT 进展减少的相关性更强。尽管基线血糖与 IMT 进展之间存在很强的关联，但葡萄糖的研究相关变化并不是 IMT 进展的重要决定因素。
阿卡波糖可延缓口服葡萄糖耐量试验定义的早期糖尿病患者颈动脉内膜中层厚度的进展。血糖、体重、胰岛素和脂质与进展风险有关，但降低血糖水平并不是 IMT 进展速度减慢的主要决定因素。阿卡波糖的血管获益可能与其降糖作用无关。
