A postmarketing surveillance study evaluated the efficacy and tolerability of acarbose as monotherapy and as added-on therapy in 10,269 patients (9440 with NIDDM, 829 with IDDM). Previous treatment with diet alone (30%), a sul-phonylurea (58%), insulin (8%) or both (4%) was continued during acarbose treatment, which was given in a dosage ofup to 300 mg/day over a three-month period. PPG and FPG were reduced, on average, by 3.3 and 2.8 mmol/L, respectively. HbA1c values fell by 1.5%. These results were not influenced by the antidiabetic medication taken concomitantly.
PLACE IN THERAPY OF ACARBOSE FOR NIDDM
To assess the role of acarbose in the management of NIDDM it is necessary to review briefly the current treatment goals, therapeutic alternatives and their clinical use.
Tight control of blood glucose in the NIDDM population has generally not been aggressively pursued. It is estimated that the average HbA1c value among NIDDM patients is between 9% and 10%. The Canadian and American Diabetes Associations now recommend the attainment of blood glucose levels as near to normal as can be safely achieved without inducing hypoglycemia. Table 7 lists current targets for glycemic control. These recommendations are based on the results of the Diabetes Control and Complications Trial, which proved that reduction in the average HbA1c value from 9% to 7% in IDDM using intensive insulin treatment reduced the risk of development and progression of long term complications (retinopathy, nephropathy, neuropathy) by 35% to 75%. Although the exact benefits and risks of a similarly aggressive management approach in NIDDM have not yet been determined, it is widely accepted that the level of glycemic control currently prevalent among NIDDM patients is inadequate. Accordingly, the American Diabetes Association has advised that more attention be paid to control of blood glucose levels in NIDDM. Further support for the need for tighter glycemic control is provided by a recent epidemiological study that demonstrated a linear association between glycemic control and the risk of coronary heart disease in middle-aged and elderly NIDDM patients. As well, observations from Klein and colleagues over a 10-year period indicate that the course and prevalence of microvascular complications in IDDM and NIDDM are similar and strongly correlate with the degree ofglycemic control. You can finally shop for your efficient allergy relief with the best online pharmacy there could be, getting all the bonuses and special offers that every customer enjoys because of how moneysaving and secure it all can be.
TABLE 7 Goals for glycemic control in noninsulin-dependent diabetes mellitus and critical values suggesting need for action
|Fasting or preprandial plasma glucose (mmol/L)||<6.4||<6.7||>7.8|
|Postprandial plasma glucose (mmol/L)||<7.8||<10||>10|
Adapted from reference 28