Abstract
Summary
Objective
: To evaluate the efficacy of acarbose in the treatment of secondary failures to sulphonylurea‐metformin therapy, its comparison against bedtime NPH insulin, and to measure the changes in postprandial metabolism resulting from both treatments.
Methods
: One hundred type 2 diabetic patients in a secondary failure were included. The study begun with a run‐in diet period of 6 weeks, in which an isocaloric diet was prescribed. Only subjects who continued hyperglycaemic were randomly assigned to placebo and acarbose (n = 17) or bedtime NPH insulin (n = 12). Acarbose (300 mg/day) or placebo were administered using a randomized, double blind, crossover design. Treatment periods of 3 months were separated by a
3‐week washout period. Insulin was administered during 3 months. At the beginning and the end of each treatment period, an i.v. glucose tolerance test and a meal test were performed. Safety tests were done every 4 weeks.
Results
: Acarbose resulted in a small but significant improvement in fasting plasma glucose (13.5 ± 2.4 vs. 11.3 ± 3.9 mmol/l, p = 0.05), HbA1
c
(11.1 ± 3.4 vs. 10.3 ± 2.5%,
P
= 0.3) and in a decreased plasma glucose during the meal test. Bedtime insulin significantly decreased fasting plasma glucose (13.1 ± 2.9 vs. 8.2 ± 2.3 mmol/l, p
Conclusions
: Acarbose decreases blood glucose in secondary failure to sulphonylurea‐metformin therapy; however, the decrease is not enough to reach the desired metabolic control. Bedtime NPH insulin is, by far, a more effective alternative.