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Cardiovascular Benefits of Acarbose vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin.
J Clin Endocrinol Metab. 2018 10 01; 103(10):3611-3619.JC

Abstract

Context

Although α-glucosidase inhibitors (AGIs) have been shown to reduce the risk of myocardial infarction in patients with impaired glucose tolerance, the cardiovascular benefits of AGIs in those with type 2 diabetes (T2D) remains unclear.

Objective

We compared the clinical outcomes of adding acarbose vs sulfonylureas to metformin therapy in patients with T2D.

Design, Setting, and Participants

The study population was drawn from the database of the Diabetes Pay-for-Performance program in Taiwan. Sulfonylureas and acarbose were prescribed to 196,143 and 14,306 patients with T2D, respectively, from 2004 to 2015, who had been treated with metformin. A propensity score-matched cohort study was conducted. The patients were followed up for clinical adverse events of all-cause mortality and hospitalizations of major atherosclerotic events (i.e., myocardial infarction and ischemic stroke), heart failure, or hypoglycemia.

Results

A total of 14,306 propensity score-matched pairs (age, 55.8 ± 13.1 years; 47.8% men) were enrolled in the present analysis. Compared with sulfonylureas as the add-on therapy to metformin, the use of acarbose was associated with significantly lower risks of hospitalizations for major atherosclerotic events [hazard ratio (HR), 0.69; 95% CI, 0.52 to 0.91], ischemic stroke (HR, 0.68; 95% CI, 0.49 to 0.94), and hypoglycemia (HR, 0.23; 95% CI, 0.08 to 0.71), after accounting for major confounding factors.

Conclusions

In T2D treatment, the use of acarbose as an add-on remedy to metformin was associated with lower risks of major atherosclerotic events, ischemic stroke, and hypoglycemia compared with the use of sulfonylurea as an add-on remedy.

Authors+Show Affiliations

Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan. Department of Medicine, National Yang-Ming University, Taipei, Taiwan. Department of Public Health, National Yang-Ming University, Taipei, Taiwan. Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.Department of Medicine, National Yang-Ming University, Taipei, Taiwan. Department of Public Health, National Yang-Ming University, Taipei, Taiwan. Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.Department of Medicine, National Yang-Ming University, Taipei, Taiwan. Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei,, Taiwan.College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.Division of Endocrinology and Metabolism, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.Dr. Yen's Clinic, Taoyuan, Taiwan.Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. Department of Health Services Administration, China Medical University, Taichung, Taiwan. Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30113697

Citation

Hsu, Pai-Feng, et al. "Cardiovascular Benefits of Acarbose Vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin." The Journal of Clinical Endocrinology and Metabolism, vol. 103, no. 10, 2018, pp. 3611-3619.
Hsu PF, Sung SH, Cheng HM, et al. Cardiovascular Benefits of Acarbose vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin. J Clin Endocrinol Metab. 2018;103(10):3611-3619.
Hsu, P. F., Sung, S. H., Cheng, H. M., Shin, S. J., Lin, K. D., Chong, K., Yen, F. S., Yu, B. H., Huang, C. T., & Hsu, C. C. (2018). Cardiovascular Benefits of Acarbose vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin. The Journal of Clinical Endocrinology and Metabolism, 103(10), 3611-3619. https://doi.org/10.1210/jc.2018-00040
Hsu PF, et al. Cardiovascular Benefits of Acarbose Vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin. J Clin Endocrinol Metab. 2018 10 1;103(10):3611-3619. PubMed PMID: 30113697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular Benefits of Acarbose vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin. AU - Hsu,Pai-Feng, AU - Sung,Shih-Hsien, AU - Cheng,Hao-Min, AU - Shin,Shyi-Jang, AU - Lin,Kun-Der, AU - Chong,Keong, AU - Yen,Fu-Shun, AU - Yu,Ben-Hui, AU - Huang,Chi-Ting, AU - Hsu,Chih-Cheng, PY - 2018/01/09/received PY - 2018/07/27/accepted PY - 2018/8/17/pubmed PY - 2019/5/22/medline PY - 2018/8/17/entrez SP - 3611 EP - 3619 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 103 IS - 10 N2 - Context: Although α-glucosidase inhibitors (AGIs) have been shown to reduce the risk of myocardial infarction in patients with impaired glucose tolerance, the cardiovascular benefits of AGIs in those with type 2 diabetes (T2D) remains unclear. Objective: We compared the clinical outcomes of adding acarbose vs sulfonylureas to metformin therapy in patients with T2D. Design, Setting, and Participants: The study population was drawn from the database of the Diabetes Pay-for-Performance program in Taiwan. Sulfonylureas and acarbose were prescribed to 196,143 and 14,306 patients with T2D, respectively, from 2004 to 2015, who had been treated with metformin. A propensity score-matched cohort study was conducted. The patients were followed up for clinical adverse events of all-cause mortality and hospitalizations of major atherosclerotic events (i.e., myocardial infarction and ischemic stroke), heart failure, or hypoglycemia. Results: A total of 14,306 propensity score-matched pairs (age, 55.8 ± 13.1 years; 47.8% men) were enrolled in the present analysis. Compared with sulfonylureas as the add-on therapy to metformin, the use of acarbose was associated with significantly lower risks of hospitalizations for major atherosclerotic events [hazard ratio (HR), 0.69; 95% CI, 0.52 to 0.91], ischemic stroke (HR, 0.68; 95% CI, 0.49 to 0.94), and hypoglycemia (HR, 0.23; 95% CI, 0.08 to 0.71), after accounting for major confounding factors. Conclusions: In T2D treatment, the use of acarbose as an add-on remedy to metformin was associated with lower risks of major atherosclerotic events, ischemic stroke, and hypoglycemia compared with the use of sulfonylurea as an add-on remedy. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/30113697/Cardiovascular_Benefits_of_Acarbose_vs_Sulfonylureas_in_Patients_With_Type_2_Diabetes_Treated_With_Metformin_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2018-00040 DB - PRIME DP - Unbound Medicine ER -