Song Lulu, Kong Xiaomu, Yang Zhaojun, Zhang Jinping, Yang Wenying, Zhang Bo, Chen Xiaoping, Wang Xin
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, People's Republic of China.
Clinical Laboratory, China-Japan Friendship Hospital, Beijing, People's Republic of China.
Diabetes Metab Syndr Obes. 2021 Nov 5;14:4451-4458. doi: 10.2147/DMSO.S325683. eCollection 2021.
To assess the effect of acarbose in lowering low-grade albuminuria compared to metformin in newly diagnosed Chinese type 2 diabetes (T2DM) patients.
The Metformin and AcaRbose Clinical Trial was a randomized, open-label trial in newly diagnosed T2DM patients. Participants received 48 weeks of monotherapy with acarbose (100 mg three times a day) or metformin (1500 mg once a day). As the hypoglycemic effect of acarbose and metformin has been evaluated in previous reports. This analysis studied the effect of the two antidiabetic drugs on reducing urinary albumin. The percent change in the urinary albumin/creatinine ratio (uACR) from baseline to week 48 was analyzed, and ANCOVA was employed to establish whether the effect in decreasing uACR was mediated by metabolic improvement.
Acarbose reduced the adjusted mean percent uACR by -31.5% (95% confidence interval [CI] -48.4 to -7.5) compared with metformin. When adjusting for changes in glycated hemoglobin, body weight, systolic blood pressure and triglycerides or changes in area under the curve of glucagon-like peptide 1 (AUCGLP-1) in the standard meal test, the uACR-lowering effect was not attenuated. If stratified by eGFR, blood glucose level, sex or uACR level, the effect of acarbose versus metformin was consistent across subgroups. The proportion of patients with a reduction in uACR of at least 70% was 48.6% in the acarbose group and 34.1% in the metformin group.
Acarbose lowered the uACR compared to metformin in newly diagnosed T2DM patients independent of improvements in hyperglycemia, blood pressure, body weight and triglycerides.
评估与二甲双胍相比，阿卡波糖对新诊断的中国2型糖尿病（T2DM）患者降低低度白蛋白尿的效果。
二甲双胍和阿卡波糖临床试验是一项针对新诊断的T2DM患者的随机、开放标签试验。参与者接受了48周的阿卡波糖（每日三次，每次100毫克）或二甲双胍（每日一次，1500毫克）单药治疗。由于之前的报告已经评估了阿卡波糖和二甲双胍的降糖效果。本分析研究了这两种抗糖尿病药物对降低尿白蛋白的作用。分析了从基线到第48周尿白蛋白/肌酐比值（uACR）的百分比变化，并采用协方差分析来确定降低uACR的效果是否由代谢改善介导。
与二甲双胍相比，阿卡波糖使调整后的uACR平均百分比降低了-31.5%（95%置信区间[CI]-48.4至-7.5）。在对糖化血红蛋白、体重、收缩压和甘油三酯的变化或标准餐试验中胰高血糖素样肽1曲线下面积（AUCGLP-1）的变化进行调整后，uACR降低效果并未减弱。如果按估算肾小球滤过率（eGFR）、血糖水平、性别或uACR水平分层，阿卡波糖与二甲双胍相比的效果在各亚组中是一致的。阿卡波糖组uACR降低至少70%的患者比例为48.6%，二甲双胍组为34.1%。
在新诊断的T2DM患者中，与二甲双胍相比，阿卡波糖降低了uACR，且独立于血糖、血压、体重和甘油三酯的改善情况。
