Hyperglycemia, particularly postpra...

Hyperglycemia, particularly postprandial hyperglycemia, is contemplation to be an independent risk factor for cardiovascular disease in patients with diabetes. The STOP-Noninsulin-Dependent Diabetes Mellitus (STOP-NIDDM) trial demonstrated that acarbose, an alpha-glucosidase inhibitor, decreased diabetes risk in patients with impaired grape-sugar tolerance. Chiasson and colleagues also attempted to determine whether decreasing postprandial hyperglycemia would decrease the risk of hypertension and cardiovascular disease.

Male and female participants were 40 to 70 years of age and had a visible form [i]or[/i] frame mass index (BMI) between 25 and 40 kg by [m.sup.2]. All had impaired grape-sugar tolerance and a fasting life-blood glucose level between 100 and 140 mg by means of dL (5.5 and 7.8 mmol by L). Participants were randomized to placebo or to 100 mg of acarbose three times a day. All were instructed to tread in the steps of a weight-reduction or a weight-maintenance diet and to exercise.

The main consequence measure was the occurrence of a major cardiovascular termination including heart disease. As a secondary objective, the power of acarbose on the exhibition of hypertension was observed. grape-sugar and lipid levels were followed. Analyses were adjusted for multiple variables, similar as lipid levels, BMI, medications, and smoking.

Overall, 1368 patients were randomized to receive acarbose (n = 682) or placebo (n = 686) with a mean follow-up of 33 years. Almost twice as many participants in the acarbose dispose (211 patients) discontinued the trial prematurely, mainly because of gastrointestinal side drifts compared with the placebo cluster (130 patients). There was no difference between the form into groupss in terms of treatment or experience of cardiovascular disease at baseline. Acarbose therapy increased the probability that patients would remain liberated of cardiovascular events (hazard ratio of 051) with 32 in the placebo assign places to and 15 in the acarbose assign places to having at least one cardiovascular consequence The relative risk reduction associated with acarbose therapy was 49 percent and the absolute risk reduction was 25 percent Besides acarbose treatment, other factors that positively correlated with cardiovascular occurrences on univariate analysis included fasting plasma grape-sugar levels, triglyceride concentrations, and systolic and diastolic children pressures. Acarbose treatment lowered the risk of developing hypertension, with 78 patients (11 percent) developing hypertension in the acarbose form into groups compared with 115 (17 percent) in the placebo collection a relative risk reduction of 34 percent and an absolute risk reduction of 53 percent

Acarbose was associated with a significant reduction in cardiovascular issues in a group of participants with impaired diabetic sugar tolerance. In addition, acarbose reduc the risk of developing hypertension. The number straited to treat to prevent undivided case of hypertension in patients with impaired grape-sugar tolerance would be 19 for 33 years. Although the reason for these risk reductions was not ascertained in the trial, it was observ that acarbose is associated with significant reductions in material part weight and other risk factors related to the evolution of cardiovascular disease. On the basis of their trial arises the authors conclude that diabetes screening should identify patients with impaired diabetic sugar tolerance and that efforts should be made to remodel postprandial hyperglycemia.

Chiasson JL et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired starch-sugar tolerance. The STOP-NIDDM Trial. JAMA July 23/30 2003;290:486-94

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