China: Acarbose and metformin are associated with reduced rates of progression to diabetes and increased rates of achieving normal blood sugar levels in patients with impaired glucose tolerance (IGT), a recent study has found. Further, acarbose use increased the rate of achieving a normal glucose level, while intensive lifestyle modification was not.
A 2017 guideline for Prevention and Control of Type 2 Diabetes in China, had recommended intensive lifestyle interventions for preventing the progression of IGT to type 2 diabetes. In case, lifestyle modification is ineffective for 6 months, acarbose and metformin can also be considered. There is no clarity however on the effects of intensive lifestyle modification and glucose-lowering drug interventions that work best in the people with IGT. To get some clarity in the topic, Yue Zhang, Shanghai Centennial Scientific Co Ltd, Shanghai, China, and colleagues assessed the effectiveness of intensive lifestyle modification, acarbose, and metformin in treating populations with IGT by conducting a network meta-analysis.
The researchers systematically searched both Chines and English databases for articles published between database inception and September 2019. Randomized, controlled clinical trials in patients with IGT treated with acarbose, metformin, and intensive lifestyle modification were assessed for eligibility.
2 reviewers independently evlaiuated the data from all included studies in accordance with the Cochrane Handbook for Systematic Reviews of Intervention version 6.0. After evaluation, the review included data from 53 randomized controlled trials, with a sample size of 21,208 patients.
Based on the review, the researchers found the following:
· Compared with the control group, the use of acarbose, metformin, and/or intensive lifestyle modification was associated with reduced rates of progression to diabetes (relative risks [RRs]: acarbose, 0.37; metformin, 0.39; intensive lifestyle modification, 0.61).
· The surface under the cumulative ranking (SUCRA) value of acarbose was 88.35%, supporting that acarbose was more effective in reducing the rate of progression to diabetes compared with controls.
· With acarbose, metformin, and intensive lifestyle modification, the rates of achieving a normal glucose level were increased by RR = 2.1, 1.7, and 1.2, respectively when compared with control group.
· The SUCRA value of acarbose was 99.69%, supporting the optimal effect of acarbose in achieving a normal blood glucose level.
In IGT patients, compared to controls, acarbose and metformin were associated with a decrease rate of progression to diabetes and an increased rate of achievement of a normal glucose level. Intensive lifestyle modification was also associated with a reduced rate of progression to diabetes, but not with an increased rate of achieving a normal glucose level, although a positive trend was seen.
The authors concluded that, "Due to the inability to quantify lifestyle-modification intensity, further studies are needed for a better understanding of the relationship between intensity of lifestyle modification and the rates of progression to diabetes and of achieving a normal glucose level."
Reference:
The study titled, "Network Meta-Analysis of the Therapeutic Effects of Hypoglycemic Drugs and Intensive Lifestyle Modification on Impaired Glucose Tolerance," is published in the journal Clinical Therapeutics.
DOI: https://www.clinicaltherapeutics.com/article/S0149-2918(21)00258-7/fulltext