BACKGROUND: It remains unclear whether lowering postprandial glucose by alpha-glucosidase inhibitors (alpha-GIs) can prevent the progression of carotid intima-media thickness (IMT). METHODS AND RESULTS: We performed a meta-analysis of all relevant randomized controlled trials (RCTs) to evaluate the effect of alpha-GIs on the progression of carotid IMT. Five RCTs with 411 patients were included in this study. Alpha-GIs therapy was associated with a significant reduction in the annual progression of carotid IMT (WMD, -0.06 mm/year, 95% CI -0.11, -0.01; P=0.02) and the progression in carotid IMT at the end of follow-up (WMD, -0.07 mm, 95% CI -0.12, -0.02; P=0.003). In subgroup analysis, alpha-GIs therapy was associated with a significant reduction in the annual progression of carotid IMT in patients with type 2 diabetes mellitus (T2DM) (WMD, -0.08 mm/year, 95% CI -0.10, -0.06; P<0.00001), and in the progression of carotid IMT in patients with impaired glucose tolerance (IGT) at the end of follow-up (WMD, -0.03 mm, 95% CI -0.05, -0.01; P=0.01). Alpha-GIs treatment was associated with significant increase in HDL-C (WMD 1.56 mg/dl, 95% CI 0.09, 3.03; P=0.04) and decrease in basal immunoreactive insulin as well as had favorable trends towards reducing HbA1c, triglyceride and diastolic blood pressure. CONCLUSION: It suggests that alpha-GIs therapy may be an effective strategy in preventing the progression of carotid IMT in patients with IGT or T2DM. It partially contributes to the improvement in atherogenic metabolic parameters induced by alpha-GIs. More studies, especially large multi-centre RCTs, are still warranted to further clarify the anti-atherosclerotic effect of alpha-GIs.
BACKGROUND: It remains unclear whether lowering postprandial glucose by alpha-glucosidase inhibitors (alpha-GIs) can prevent the progression of carotid intima-media thickness (IMT). METHODS AND RESULTS: We performed a meta-analysis of all relevant randomized controlled trials (RCTs) to evaluate the effect of alpha-GIs on the progression of carotid IMT. Five RCTs with 411 patients were included in this study. Alpha-GIs therapy was associated with a significant reduction in the annual progression of carotid IMT (WMD, -0.06 mm/year, 95% CI -0.11, -0.01; P=0.02) and the progression in carotid IMT at the end of follow-up (WMD, -0.07 mm, 95% CI -0.12, -0.02; P=0.003). In subgroup analysis, alpha-GIs therapy was associated with a significant reduction in the annual progression of carotid IMT in patients with type 2 diabetes mellitus (T2DM) (WMD, -0.08 mm/year, 95% CI -0.10, -0.06; P<0.00001), and in the progression of carotid IMT in patients with impaired glucose tolerance (IGT) at the end of follow-up (WMD, -0.03 mm, 95% CI -0.05, -0.01; P=0.01). Alpha-GIs treatment was associated with significant increase in HDL-C (WMD 1.56 mg/dl, 95% CI 0.09, 3.03; P=0.04) and decrease in basal immunoreactive insulin as well as had favorable trends towards reducing HbA1c, triglyceride and diastolic blood pressure. CONCLUSION: It suggests that alpha-GIs therapy may be an effective strategy in preventing the progression of carotid IMT in patients with IGT or T2DM. It partially contributes to the improvement in atherogenic metabolic parameters induced by alpha-GIs. More studies, especially large multi-centre RCTs, are still warranted to further clarify the anti-atherosclerotic effect of alpha-GIs.
Authors: Louise Lundby-Christensen; Lise Tarnow; Trine W Boesgaard; Søren S Lund; Niels Wiinberg; Hans Perrild; Thure Krarup; Ole Snorgaard; Birthe Gade-Rasmussen; Birger Thorsteinsson; Michael Røder; Elisabeth R Mathiesen; Tonny Jensen; Henrik Vestergaard; Christoffer Hedetoft; Leif Breum; Elsebeth Duun; Simone B Sneppen; Oluf Pedersen; Bianca Hemmingsen; Bendix Carstensen; Sten Madsbad; Christian Gluud; Jørn Wetterslev; Allan Vaag; Thomas P Almdal Journal: BMJ Open Date: 2016-02-25 Impact factor: 2.692
Authors: Ruth L Coleman; Charles A B Scott; Zhihui Lang; M Angelyn Bethel; Jaakko Tuomilehto; Rury R Holman Journal: Cardiovasc Diabetol Date: 2019-10-17 Impact factor: 9.951
Authors: Eberhard Standl; Michael J Theodorakis; Michael Erbach; Oliver Schnell; Jaakko Tuomilehto Journal: Cardiovasc Diabetol Date: 2014-04-16 Impact factor: 9.951