Meta-analysis and critical review on the efficacy and safety of alpha glucosidase inhibitors in Asian and non-Asian populations.

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Term Occurence Count Dictionary
acarbose 8 endocrinologydiseasesdrugs
diabetes mellitus 12 endocrinologydiseases
hypoglycemia 16 endocrinologydiseases
metformin 2 endocrinologydiseasesdrugs
miglitol 3 endocrinologydiseasesdrugs
type 2 diabetes mellitus 9 endocrinologydiseases

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Select Drug Character Offset Drug Term Instance
acarbose 4783 collected until December 2016. The search was carried out using the following terms: type 2 diabetes, AGI, acarbose , voglibose, miglitol, RCTs and clinical trials.Study selection and data extractionStudies selected from
acarbose 25532 Van de Laar et al.73 showed that in clinical trials (36 trials in Caucasians and 5 trials in Asians), acarbose decreased HbA1c by 0.77%, miglitol by 0.68% and voglibose yielded a difference of 0.47%. For FPG, acarbose
acarbose 25639 acarbose decreased HbA1c by 0.77%, miglitol by 0.68% and voglibose yielded a difference of 0.47%. For FPG, acarbose was associated with a mean FPG reduction of 1.09 mmol/L, miglitol 0.52 mmol/L and voglibose 0.60 mmol/L.
acarbose 25949 comparable between AGI treatment and the placebo. However, they found a small effect of −0.09 mmol/L for acarbose on TG that was borderline statistically significant (95% CI 0.18 to 0.00, P = 0.06), which was nearly
acarbose 26256 another meta‐analysis by Hanefeld et al.74 also showed that TG levels significantly decreased during acarbose treatment compared with the placebo (P < 0.001). AGI acts by delaying the enzymatic breakdown of carbohydrates
acarbose 27927 flatulence, diarrhea, abdominal pain and constipation. Van de Laar et al.73 found that patients treated with acarbose had significantly more gastrointestinal adverse effects, and these adverse effects were dose‐dependent.
acarbose 28877 PPG. Consistent with the present results, another meta‐analysis in 2013 by Zhu et al.75 showed that acarbose monotherapy generally had a similar ability to MET, SU and glinides to reduce HbA1c levels. However,
acarbose 29047 glinides to reduce HbA1c levels. However, different from the present results, Zhu et al.75 found that acarbose achieved a greater absolute reduction of HbA1c levels with Eastern diets (East and Southeast Asian countries)
metformin 8533 other OHAs, such as dipeptidyl peptidase‐4 (DPP‐4) inhibitors7, 19, 20, 21, 22, 23, 24, 25, 26, metformin (MET)27, 28, sulfonylureas (SU)29, 30, 31, 32, glinides33, 34, 35 and thiazolidinedione (TZD)30, 36.
metformin 21637 DPP‐4 inhibitors, dipeptidyl peptidase‐4; FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; MET, metformin ; PPG, postprandial plasma glucose; SU, sulfonylureas; TZD, thiazolidinedione.John Wiley & Sons, LtdIn
miglitol 4804 2016. The search was carried out using the following terms: type 2 diabetes, AGI, acarbose, voglibose, miglitol , RCTs and clinical trials.Study selection and data extractionStudies selected from the databases were
miglitol 25567 clinical trials (36 trials in Caucasians and 5 trials in Asians), acarbose decreased HbA1c by 0.77%, miglitol by 0.68% and voglibose yielded a difference of 0.47%. For FPG, acarbose was associated with a mean FPG
miglitol 25705 yielded a difference of 0.47%. For FPG, acarbose was associated with a mean FPG reduction of 1.09 mmol/L, miglitol 0.52 mmol/L and voglibose 0.60 mmol/L. Van de Laar et al.73 also found that bodyweight change, and TC,
Select Disease Character Offset Disease Term Instance
diabetes mellitus 2238 by elevated plasma glucose levels, and a series of macrovascular and microvascular disorders. Type 2 diabetes mellitus , which accounts for at least 90% of diabetes mellitus, is characterized by insulin resistance and the
diabetes mellitus 2292 macrovascular and microvascular disorders. Type 2 diabetes mellitus, which accounts for at least 90% of diabetes mellitus , is characterized by insulin resistance and the progressive loss of pancreatic β‐cell function. The
diabetes mellitus 2434 insulin resistance and the progressive loss of pancreatic β‐cell function. The prevalence of type 2 diabetes mellitus has increased rapidly in Asian countries in recent years. Currently, China has the largest diabetic
diabetes mellitus 3053 inhibiting the alpha‐glucosidase enzymes, are widely used in the treatment of patients with type 2 diabetes mellitus 2. AGI is one of the second‐line oral hypoglycemic agents (OHAs), and is usually used as monotherapy
diabetes mellitus 4249 hypothesized that because of the different percentage of carbohydrates in the diets of Asian type 2 diabetes mellitus patients and non‐Asian type 2 diabetes mellitus patients, and according to the previous study published,
diabetes mellitus 4299 percentage of carbohydrates in the diets of Asian type 2 diabetes mellitus patients and non‐Asian type 2 diabetes mellitus patients, and according to the previous study published, there might be different efficacy in α‐glucosidase
diabetes mellitus 5764 (v) trials were double‐blind RCTs. Exclusion criteria were: (i) non‐RCTs carried out in type 2 diabetes mellitus patients; (ii) trials in type 1 diabetes patients; and (iii) study duration <12 weeks. A study was categorized
diabetes mellitus 10525 presented as mean ± standard deviation. AGI, alpha‐glucosidase inhibitor; BMI, body mass index; DM, diabetes mellitus ; HbA1c, hemoglobin A1c; OHA, oral hypoglycemic agents.John Wiley & Sons, LtdMethodological qualityAll
diabetes mellitus 11297 (results are shown in Figure S1).Efficacy and adverse effects of AGI treatment vs placebo in Asian type 2 diabetes mellitus patientsPooled analysis of the data from Asian patients showed that treatment with AGI was associated
diabetes mellitus 14908 1.78–5.94, P = 0.0001).Efficacy and adverse effects of AGI treatment vs placebo in Non‐Asian type 2 diabetes mellitus patientsAnalysis of the data from non‐Asian patients showed that treatment with AGI was associated
diabetes mellitus 29356 patients. On the basis of this phenomenon, the author suggested that AGI was more efficacious in type 2 diabetes mellitus patients with the Eastern diet, which was attributed to the specific mechanism of AGI. However, we did
diabetes mellitus 31970 meta‐analysis had its limitation in analyzing the percentage of carbohydrates in Asian and Caucasian type 2 diabetes mellitus patients due to the absence of data in the included studies. This might be a new point in our future
hypoglycemia 1222 in HbA1c change, fasting plasma glucose change, postprandial plasma glucose change or incidence of hypoglycemia between Asian and non‐Asian patients. AGI vs active controls: in Asian patients, AGI treatment showed
hypoglycemia 1859 glycemic control and bodyweight reduction were superior to the placebo without an increased incidence of hypoglycemia , but with an increased incidence of gastrointestinal discomforts. The hypoglycemic effects of AGI were
hypoglycemia 3417 assessed the efficacy of AGI in lowering plasma glucose levels, as well as bodyweight, with a low risk of hypoglycemia compared with a placebo or other OHAs in both Asian and non‐Asian patients4, 5, 6, 7. Similarly, literature
hypoglycemia 6696 from baseline to study end‐points for HbA1c, FPG, PPG, bodyweight, TC, TG, LDL, HDL, incidence of hypoglycemia , flatulence, diarrhea, abdominal pain, constipation).Statistical analysisAll statistical analyses were
hypoglycemia 14466 & Sons, LtdCompared with placebo therapy, treatment with AGI did not show an increased incidence of hypoglycemia (OR 1.25, 95% CI 0.82–1.91, P = 0.30) in Asian patients. AGI also did not increase the incidence of
hypoglycemia 14581 (OR 1.25, 95% CI 0.82–1.91, P = 0.30) in Asian patients. AGI also did not increase the incidence of hypoglycemia when used as an add‐on therapy. Compared with the placebo, treatment with AGI led to a significantly
hypoglycemia 16127 shown in Table 2).Compared with placebo therapy, treatment with AGI showed an increased incidence of hypoglycemia (OR 1.75, 95% CI 1.19–2.55, P = 0.004) in terms of all included patients. When used as an add‐on
hypoglycemia 16292 all included patients. When used as an add‐on therapy, AGI also showed an increased incidence of hypoglycemia (OR 1.96, 95% CI 1.27–3.03, P = 0.002). However, when used as a monotherapy, AGI showed a comparable
hypoglycemia 16421 1.27–3.03, P = 0.002). However, when used as a monotherapy, AGI showed a comparable incidence of hypoglycemia with the placebo. Compared with placebo therapy, AGI treatment showed an increased incidence of flatulence
hypoglycemia 17500 observed in the incidence of flatulence and abdominal pain. Compared with the placebo, the incidence of hypoglycemia in AGI treatment was comparable between Asian and non‐Asian patients (details are shown in Table 3).Table
hypoglycemia 24212 changes between Asian and non‐Asian patients were also comparable. In addition, the incidence of hypoglycemia , flatulence, diarrhea, and constipation were comparable between Asian and non‐Asian populations. However,
hypoglycemia 26892 intestine without promoting the secretion of insulin. Therefore, AGI treatment did not increase the risk of hypoglycemia when used as a monotherapy according to the results of many previous studies20, 27, 44, which were consistent
hypoglycemia 27151 our meta‐analysis also found that AGI as add‐on therapy was associated with an increased risk of hypoglycemia in non‐Asian populations. This phenomenon could be attributed to the use of combined agents, such
hypoglycemia 27367 SU, glinides and DPP‐4 inhibitors, which could promote insulin secretion and increase the risk of hypoglycemia accordingly.The incidence of flatulence, abdominal pain, and constipation were comparable between Asian
hypoglycemia 32270 glycemic control and bodyweight reduction were superior to the placebo, without an increased incidence of hypoglycemia , whereas with an increased incidence of gastrointestinal discomforts. The hypoglycemic effect of AGI
hypoglycemia 32514 other OHAs, such as MET, SU, TZD and DPP‐4 inhibitors. Additionally, the hypoglycemic effects and hypoglycemia risk of AGI treatment were comparable between Asian and non‐Asian type 2 diabetes patients.DisclosureThe
type 2 diabetes mellitus 2427 by insulin resistance and the progressive loss of pancreatic β‐cell function. The prevalence of type 2 diabetes mellitus has increased rapidly in Asian countries in recent years. Currently, China has the largest diabetic
type 2 diabetes mellitus 3046 tract by inhibiting the alpha‐glucosidase enzymes, are widely used in the treatment of patients with type 2 diabetes mellitus 2. AGI is one of the second‐line oral hypoglycemic agents (OHAs), and is usually used as monotherapy
type 2 diabetes mellitus 4242 It was hypothesized that because of the different percentage of carbohydrates in the diets of Asian type 2 diabetes mellitus patients and non‐Asian type 2 diabetes mellitus patients, and according to the previous study published,
type 2 diabetes mellitus 4292 percentage of carbohydrates in the diets of Asian type 2 diabetes mellitus patients and non‐Asian type 2 diabetes mellitus patients, and according to the previous study published, there might be different efficacy in α‐glucosidase
type 2 diabetes mellitus 5757 study; and (v) trials were double‐blind RCTs. Exclusion criteria were: (i) non‐RCTs carried out in type 2 diabetes mellitus patients; (ii) trials in type 1 diabetes patients; and (iii) study duration <12 weeks. A study was categorized
type 2 diabetes mellitus 11290 (results are shown in Figure S1).Efficacy and adverse effects of AGI treatment vs placebo in Asian type 2 diabetes mellitus patientsPooled analysis of the data from Asian patients showed that treatment with AGI was associated
type 2 diabetes mellitus 14901 CI 1.78–5.94, P = 0.0001).Efficacy and adverse effects of AGI treatment vs placebo in Non‐Asian type 2 diabetes mellitus patientsAnalysis of the data from non‐Asian patients showed that treatment with AGI was associated
type 2 diabetes mellitus 29349 diabetes patients. On the basis of this phenomenon, the author suggested that AGI was more efficacious in type 2 diabetes mellitus patients with the Eastern diet, which was attributed to the specific mechanism of AGI. However, we did
type 2 diabetes mellitus 31963 meta‐analysis had its limitation in analyzing the percentage of carbohydrates in Asian and Caucasian type 2 diabetes mellitus patients due to the absence of data in the included studies. This might be a new point in our future

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