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[IP] Acarbose for the Prevention of Diabetes

>From the Lancet:  Volume 359, Number 9323     15 June 2002

Background:   The worldwide increase in type 2 diabetes mellitus is becoming
a major health concern. We aimed to assess the effect of acarbose in
preventing or delaying conversion of impaired glucose tolerance to type 2

Methods:   In a multicentre, placebo-controlled randomised trial, we
randomly allocated patients with impaired glucose tolerance to 100 mg
acarbose or placebo three times daily. The primary endpoint was development
of diabetes on the basis of a yearly oral glucose tolerance test (OGTT).
Analyses were by intention to treat.

Findings:   We randomly allocated 714 patients with impaired glucose
tolerance to acarbose and 715 to placebo. We excluded 61 (4%) patients
because they did not have impaired glucose tolerance or had no
postrandomisation data. 211 (31%) of 682 patients in the acarbose group and
130 (19%) of 686 on placebo discontinued treatment early. 221 (32%) patients
randomised to acarbose and 285 (42%) randomised to placebo developed
diabetes (relative hazard 0775 [95% CI 0763-0790]; p=070015). Furthermore,
acarbose significantly increased reversion of impaired glucose tolerance to
normal glucose tolerance (p<070001). At the end of the study, treatment with
placebo for 3 months was associated with an increase in conversion of
impaired glucose tolerance to diabetes. The most frequent side-effects to
acarbose treatment were flatulence and diarrhoea.

Interpretation:   Acarbose could be used, either as an alternative or in
addition to changes in lifestyle, to delay development of type 2 diabetes in
patients with impaired glucose tolerance. 
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