Treating postprandial hyperglycemia does not appear to delay progression of early type 2 diabetes: the Early Diabetes Intervention Program.

Abstract

OBJECTIVE:

Postprandial hyperglycemia characterizes early type 2 diabetes. We investigated whether ameliorating postprandial hyperglycemia with acarbose would prevent or delay progression of diabetes, defined as progression to frank fasting hyperglycemia, in subjects with early diabetes (fasting plasma glucose [FPG] <140 mg/dl and 2-h plasma glucose > or =200 mg/dl).

RESEARCH DESIGN AND METHODS:

Two hundred nineteen subjects with early diabetes were randomly assigned to 100 mg acarbose t.i.d. or identical placebo and followed for 5 years or until they reached the primary outcome (two consecutive quarterly FPG measurements of > or =140 mg/dl). Secondary outcomes included measures of glycemia (meal tolerance tests, HbA(1c), annual oral glucose tolerance tests [OGTTs]), measures of insulin resistance (homeostasis model assessment [HOMA] of insulin resistance and insulin sensitivity index from hyperglycemic clamps), and secondary measures of beta-cell function (HOMA-beta, early- and late-phase insulin secretion, and proinsulin-to-insulin ratio).

RESULTS:

Acarbose significantly reduced postprandial hyperglycemia. However, there was no difference in the cumulative rate of frank fasting hyperglycemia (29% with acarbose and 34% with placebo; P = 0.65 for survival analysis). There were no significant differences between groups in OGTT values, measures of insulin resistance, or secondary measures of beta-cell function. In a post hoc analysis of subjects with initial FPG <126 mg/dl, acarbose reduced the rate of development of FPG > or =126 mg/dl (27 vs. 50%; P = 0.04).

CONCLUSIONS:

Ameliorating postprandial hyperglycemia did not appear to delay progression of early type 2 diabetes. Factors other than postprandial hyperglycemia may be greater determinants of progression of diabetes. Alternatively, once FPG exceeds 126 mg/dl, beta-cell failure may no longer be remediable.

• Authors: M Sue Kirkman, R Ravi Shankar, Sudha Shankar, Changyu Shen, Edward Brizendine, Alain Baron, Janet McGill
• Journal: Diabetes care (Diabetes Care) Vol. 29 Issue 9 Pg. 2095-101 (Sep 2006) ISSN: 0149-5992 [Print] United States
• PMID: 16936159 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Hypoglycemic Agents
• Acarbose

Topics

• Acarbose (administration & dosage, therapeutic use)
• Adult
• Blood Glucose (analysis)
• Diabetes Mellitus, Type 2 (blood, drug therapy, pathology)
• Disease Progression
• Female
• Humans
• Hyperglycemia (blood, drug therapy)
• Hypoglycemic Agents (administration & dosage, therapeutic use)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Postprandial Period
• Treatment Outcome