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Drugs

, Volume 44, Supplement 3, pp 54–60 | Cite as

Preventing Long Term Complications

Implications for Combination Therapy with Acarbose
  • Bruce R. Zimmerman
Article

Summary

Long term complications continue to be the major source of morbidity and mortality in patients with diabetes. Acarbose could potentially help to reduce diabetic complications if it improved glucose control, reduced lipid levels and hyperinsulinaemia. Acarbose has been shown to effectively reduce postprandial hyperglycaemia and haemoglobin A1c. This effect might be helpful in patients with insulin-dependent diabetes mellitus, as insulin injections do not provide complete control of rises in postprandial glucose levels, and in patients with non-insulin-dependent diabetes mellitus, because it simplifies the treatment programme. If improved control is shown to reduce complications, acarbose may be helpful. Although acarbose does not reduce hyperinsulinaemia, it reduces lipid levels and thus could reduce the risk of atherosclerosis.

Keywords

Sulfonylurea Diabetic Complication Acarbose Blood Glucose Control Postprandial Hyperglycaemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. American Diabetes Association. Consensus statement: role of cardiovascular risk factors in prevention and treatment of macrovascular disease in diabetes. Diabetes Care 12: 573–579, 1989Google Scholar
  2. Brownlee M, Cerami A, Vlassara H. Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. New England Journal of Medicine 318: 1315–1321, 1988PubMedCrossRefGoogle Scholar
  3. Clissold SP, Edwards C. Acarbose: a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential. Drugs 35: 214–243, 1988PubMedCrossRefGoogle Scholar
  4. Cohen AM, Rosenmann E. Acarbose treatment and diabetic nephropathy in the Cohen diabetic rat. Hormone Metabolism Research 22: 511–515, 1990CrossRefGoogle Scholar
  5. Covet C, Ulmer M, Hamdaovi M, Bau HM, Debry G. Metabolic effects of acarbose in healthy men. European Journal of Clinical Nutrition 43: 187–196, 1989Google Scholar
  6. DCCT Research Group. Diabetes Control and Complications Trial (DCCT): results of feasibility study. Diabetes Care 10: 1–19, 1987CrossRefGoogle Scholar
  7. DeFronzo RA, Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 14: 173–194, 1991PubMedCrossRefGoogle Scholar
  8. Engerman RL, Kern TS. Progression of incipient diabetic retinopathy during good glycemic control. Diabetes 36: 808–812, 1987PubMedCrossRefGoogle Scholar
  9. Feldt-Rasmussen B, Mathiesen ER, Jensen T, Lauritzen T, Deckert T. Effect of improved metabolic control on loss of kidney function in type I (insulin dependent) diabetic patients: an update of the Steno studies. Diabetologia 34: 164–170, 1991PubMedCrossRefGoogle Scholar
  10. Fontbonne AM, Eschwége EM. Insulin and cardiovascular disease: Paris prospective study. Diabetes Care 14: 461–469, 1991PubMedCrossRefGoogle Scholar
  11. Greene DA, Lattimer SA, Sima AAF. Sorbitol, phosphoinositides, and sodium-potassium-ATPase in the pathogenesis of diabetic complications. New England Journal of Medicine 316: 599–606, 1987PubMedCrossRefGoogle Scholar
  12. Hanefeld M, Fischer S, Schmechel H, Rothe G, Schulze J, et al. Diabetes intervention study: multi-intervention trial in newly diagnosed NIDDM. Diabetes Care 14: 308–317, 1991PubMedCrossRefGoogle Scholar
  13. Innerfield R, Coniff RF, Shapiro JA, Collins S. A multicentre randomized comparative study of the efficacy of diet alone, acarbose (BAY g 5421) and diet, tolbutamide and diet, and acarbose (BAY g 5421) together with tolbutamide in the treatment of non-insulin-dependent (Type II) diabetes mellitus. Miles Medical Research Report Number 0992, 1989Google Scholar
  14. Lebovitz HE. Oral antidiabetic agents: the emergence of α-glucosidase inhibitors. Drugs 44 (Suppl. 3): 21–28, 1992PubMedCrossRefGoogle Scholar
  15. Lorenz R, Siebert C, Geary P, Santiago J, Heyse S. Epidemiology of severe hypoglycemia in the DCCT. Diabetes 37 (Suppl. 1): 3A, 1988CrossRefGoogle Scholar
  16. Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diabetes Care 1: 168–188, 252-263, 1978Google Scholar
  17. Pyörälä K. Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: results from two population studies in Finland. Diabetes Care 2: 131–141, 1979PubMedCrossRefGoogle Scholar
  18. Reaven GM. Banting Lecture 1988: role of insulin resistance in human disease. Diabetes 37: 1595–1607, 1988PubMedCrossRefGoogle Scholar
  19. Reaven GM. Insulin resistance, hyperinsulinemia, hypertriglyceridemia, and hypertension: parallels between human disease and rodent models. Diabetes Care 14: 195–202, 1991PubMedCrossRefGoogle Scholar
  20. Reaven GM, Lardinois CK, Greenfield MS, Schwartz HC, Vreman HJ. Effect of acarbose on carbohydrate and lipid metabolism in NIDDM patients poorly controlled by sulfonylureas. Diabetes Care 13 (Suppl. 3): 32–36, 1990PubMedGoogle Scholar
  21. Ricordi C, Tzakis A, Alejandro R, Zeng Y, Demetris AJ, et al. Detection of pancreatic islet tissue following islet allotransplantation in man. Transplantation 52: 1079–1107, 1991PubMedCrossRefGoogle Scholar
  22. Schnack C, Prager RJF, Winkler J, Klauser RM, Schneider BG, et al. Effects of 8-week alpha-glucosidase inhibition on metabolic control. C-peptide secretion, hepatic glucose output, and peripheral insulin sensitivity in poorly controlled Type II diabetic patients. Diabetes Care 12: 537–543, 1989Google Scholar
  23. Service FJ, Zimmerman BR, Rizza RA, Velosa JA, Frohnert PP, et al. Long-term metabolic control of IDDM who have received pancreatic allografts. Poster: Third International Congress on Pancreatic and Islet Transplantation, Lyon, June 1991Google Scholar
  24. Tzakis A, Ricordi C, Alejandro R, et al. Pancreatic islet transplantation after upper abdominal exenteration and liver replacement. Lancet 336: 402, 1990PubMedCrossRefGoogle Scholar
  25. Walter-Sack IE, Wolfram G, Zollner N. Effects of acarbose on serum lipoproteins in healthy individuals during prolonged administration of a fiber-free formula diet. Annals of Nutrition Metabolism 33: 100–107, 1989PubMedCrossRefGoogle Scholar
  26. Welborn TA, Wearne K. Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care 2: 154–160, 1979PubMedCrossRefGoogle Scholar
  27. Zimmerman BR. Current status of aldose reductase inhibitors. Diabetes Care 10: 123–125, 1987PubMedGoogle Scholar
  28. Zimmerman BR. Influence of the degree of control of diabetes on the prevention, postponement, and amelioration of late complications. Drugs 38: 941–946, 1989PubMedCrossRefGoogle Scholar
  29. Zimmerman BR, Palumbo PJ, O’Fallon WM, Ellefson RD, Osmundson PJ, et al. A prospective study of peripheral occlusive arterial disease in diabetes. III. Initial lipid and lipoprotein findings. Mayo Clinic Proceedings 56: 233–242, 1981PubMedGoogle Scholar

Copyright information

© Adis International Limited 1992

Authors and Affiliations

  • Bruce R. Zimmerman
    • 1
  1. 1.Division of EndocrinologyMayo ClinicRochesterUSA

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