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Can Acarbose Slow Progression of Thickening of the Carotid Artery Wall?

Acarbose treatment shows major benefits for type 2s…. 

Previous studies have demonstrated that large variations in blood glucose are associated with increased development of CVD while studies assessing the use of antidiabetic medications such as acarbose (and other alpha glucosidase inhibitors) have shown the ability to reduce CVD development. A meta-analysis of these studies revealed a delay in progression of carotid IMT.

A recent study assessed the potential of other benefits of acarbose which may be related to delaying progression of IMT. Data collected in the 2006 Early Diabetes Intervention Project (EDIP) — a randomized, controlled, acarbose vs. placebo trial involving 219 pre-diabetes participants — was analyzed via univariate and multivariate correlation analysis. The variables of interest including (but not limited to) age, gender, weight, A1C%, fasting glucose, fasting insulin level, OGGT blood glucose, fasting NEFA levels, diastolic and systolic blood pressure, and total/LDL/HDL cholesterol were assessed for correlation to carotid IMT at baseline and at 1 year (progression).

With respect to progression of carotid IMT and univariate analysis, the study showed the variables that were statistically significant for reducing carotid IMT progression included higher age, higher OGTT glucose measurements (120 min and excursion AUC), higher systolic blood pressure, lower fasting insulin concentrations and lower baseline LDL cholesterol. When the model was assessed via multivariate analysis, higher weight, lower fasting insulin, higher LDL cholesterol, higher glycated LDL and/or lower fasting NEFA retained independent correlation with delayed progression of carotid IMT. These findings may suggest that other benefits besides glucose lowering effects gained from the use of acarbose may be at least partially responsible for delay of carotid IMT.

In conclusion, acarbose was able to delay progression of carotid intima–media thickness (IMT) which may be independent of its blood glucose lowering properties.

This study does provoke interest in #1) the other factors that may be associated with carotid IMT progression and #2) the other benefits associated with treatment with acarbose. Further large scale studies focusing on these variables and treatment with acarbose are needed to strengthen the association noted in this study.

Practice Pearls
  • Carotid intima–media thickness (IMT) is measured to determine the presence of atherosclerotic disease and is predictive of future cardiovascular events/cardiovascular disease.
  • Acarbose (Precose®) is an alpha-glucosidase inhibitor causing a delay in hydrolysis of complex carbohydrates thus reducing post prandial glucose peaks and overall blood glucose variability.
  • Large blood glucose variability can lead to cardiovascular disease however Acarbose also demonstrates improvements on weight, fasting insulin, and/or fasting non-esterfied fatty acids (NEFA) levels which may also slow progression of carotid IMT.

Patel, Y.R. et al. Effect of Acarbose To Delay Progression of Carotid Intima–Media Thickness In Early Diabetes. Diabetes Metab Res Rev 2013; 29: 582–591.