Objective: Acarbose is proved to improve glucose control and glucose variability in T2DM. However, few studies focused on the effect of acarbose in T1DM. We hereby evaluated the efficacy and safety of adding acarbose to insulin in T1DM.

Methods: A literature search on PubMed/Medline, Web of Science, Cochrane Library, Embase, Clinicaltrails.gov, CNKI, Wanfang Database and VIP Database for articles published before November 30, 2020 was performed to identify randomized controlled trials (RCTs) that investigated the efficacy of acarbose adding to insulin therapy among T1DM patients. Statistical analyses were performed by using Revman 5.3.

Results: A total of 7 RCTs with 517 patients were included. The age of participants was 18 to 65 years, and the intervention duration ranged from 7 to 24 weeks. Compared with placebo, the addition of acarbose resulted in decreased HbA1c (SMD= -0.27%, 95% CI: -1.17%~ -0.63%), mean blood glucose (SMD= -1.88 mmol/L, 95% CI: -2.75~ -1.01 mmol/L), fasting plasma blood glucose (FBG, SMD= -0.98 mmol/L, 95% CI: -3.32~ -0.63 mmol/L), 2h postprandial blood glucose (PPG, SMD= -2.65 mmol/L, 95% CI: -3.58~ -1.71 mmol/L), total daily insulin dose (SMD= -0.34 U, 95% CI: -0.52~ -0.15 U), and improved glucose variability parameters including MAGE (SMD= -1.42 mmol/L, 95% CI: -2.27~ -0.57 mmol/L) and the LAGE (SMD= -1.36 mmol/L, 95% CI: -2.41~ -0.30 mmol/L). The change of body weight and lipid profiles were similar between the two groups. In terms of adverse events, acarbose increased the risk of gastrointestinal complaints (OR= 1.80, 95% CI: 1.52~ 2.13), while the occurrence of hypoglycemia was similar (SMD= -0.93, 95% CI: -2.60~0.74).

Conclusion: The addition of acarbose to insulin could improve overall glucose control in T1DM patients, including HbA1c, mean blood glucose, FBG, PPG, and glucose variability as well. However, gastrointestinal adverse effects should be considered although acarbose did not increase the risk of hypoglycemia in this population.

Disclosure

Z. Liu: None. D. Yang: None. W. Xu: None. J. Lv: None. H. Lin: None. Z. Liu: None. H. Deng: None. J. Yan: None. B. Yao: None.

Funding

National Key Research and Development Project of China (2017YFC1309602)

© 2021 by the American Diabetes Association
2021
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