Former employee of Unilever Research and Development, Vlaardingen, The Netherlands.
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Nutr Diabetes. 2021 Mar 3;11(1):11. doi: 10.1038/s41387-021-00152-5.
BACKGROUND/OBJECTIVES: Despite considerable literature supporting the potential health benefits of reducing postprandial glucose (PPG), and insulin (PPI) exposures, the size of a clinically relevant reduction is currently unknown. We performed a systematic review and meta-analysis to quantify effects of alpha-glucosidase-inhibiting (AGI) drugs on acute PPG and PPI responses.
We searched EMBASE and MEDLINE until March 13, 2018 for controlled studies using AGI drugs together with a standardized carbohydrate load or mixed meal. The mean incremental PPG and PPI levels were calculated as outcomes. Meta-analyses, stratified by diabetes state, were performed by using random effects models.
The 66 included publications comprised 127 drug-control comparisons for PPG, and 106 for PPI, mostly testing acarbose or miglitol. The absolute effects on PPG were larger among individuals with diabetes (-1.5 mmol/l mean PPG [95% CI -1.9, -1.1] by acarbose, and -1.6 [-1.9, -1.4] by miglitol) as compared to individuals without diabetes (-0.4 [95% CI -0.5, -0.3] by acarbose, and -0.6 [-0.8, -0.4] by miglitol). Relative reductions in PPG by both drugs were similar for diabetic and non-diabetic individuals (43-54%). Acarbose and miglitol also significantly reduced mean PPI, with absolute and relative reductions being largest among individuals without diabetes.
The present meta-analyses provide quantitative estimates of reductions of PPG and PPI responses by AGI drugs in diabetes and non-diabetic individuals. These data can serve as benchmarks for clinically relevant reductions in PPG and PPI via drug or diet and lifestyle interventions.
背景/目的：尽管有大量文献支持降低餐后血糖（PPG）和胰岛素（PPI）暴露的潜在健康益处，但目前尚不清楚临床相关降低幅度有多大。我们进行了系统评价和荟萃分析，以量化α-葡萄糖苷酶抑制剂（AGI）药物对急性 PPG 和 PPI 反应的影响。
我们检索了 EMBASE 和 MEDLINE，截至 2018 年 3 月 13 日，查找使用 AGI 药物与标准化碳水化合物负荷或混合餐一起使用的对照研究。计算平均增量 PPG 和 PPI 水平作为结果。采用随机效应模型，按糖尿病状态进行分层进行荟萃分析。
纳入的 66 篇文献包括 127 项用于 PPG 的药物对照比较，106 项用于 PPI，主要测试阿卡波糖或米格列醇。与非糖尿病个体相比，糖尿病个体的绝对 PPG 影响更大（阿卡波糖时为 1.5mmol/l 平均 PPG[95%CI 1.9,1.1]，米格列醇时为 1.6mmol/l[95%CI 1.9,1.4]）（阿卡波糖时为 0.4mmol/l[95%CI 0.5,0.3]，米格列醇时为 0.6mmol/l[95%CI 0.8,0.4]）。两种药物对 PPG 的相对降低在糖尿病和非糖尿病个体中相似（43-54%）。阿卡波糖和米格列醇也显著降低平均 PPI，在非糖尿病个体中绝对和相对降低幅度最大。
本荟萃分析提供了 AGI 药物在糖尿病和非糖尿病个体中降低 PPG 和 PPI 反应的定量估计。这些数据可以作为通过药物或饮食和生活方式干预降低 PPG 和 PPI 的临床相关降低的基准。
