Cardiovascular benefits of acarbose vs sulfonylureas in patients with type 2 diabetes treated with metformin

Pai Feng Hsu, Shih Hsien Sung, Hao Min Cheng, Shyi Jang Shin, Kun Der Lin, Keong Chong, Fu Shun Yen, Ben Hui Yu, Chi Ting Huang, Chih Cheng Hsu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Context: Although a-glucosidase inhibitors (AGIs) have been shown to reduce the risk of myocardial infarction in patients with impaired glucose tolerance, the cardiovascular benefits of AGIs in those with type 2 diabetes (T2D) remains unclear. Objective: We compared the clinical outcomes of adding acarbose vs sulfonylureas to metformin therapy in patients with T2D. Design, Setting, and Participants: The study population was drawn from the database of the Diabetes Pay-for-Performance program in Taiwan. Sulfonylureas and acarbose were prescribed to 196,143 and 14,306 patients with T2D, respectively, from 2004 to 2015, who had been treated with metformin. A propensity score-matched cohort study was conducted. The patients were followed up for clinical adverse events of all-cause mortality and hospitalizations of major atherosclerotic events (i.e., myocardial infarction and ischemic stroke), heart failure, or hypoglycemia. Results: A total of 14,306 propensity score-matched pairs (age, 55.8 6 13.1 years; 47.8% men) were enrolled in the present analysis. Compared with sulfonylureas as the add-on therapy to metformin, the use of acarbose was associated with significantly lower risks of hospitalizations for major atherosclerotic events [hazard ratio (HR), 0.69; 95% CI, 0.52 to 0.91], ischemic stroke (HR, 0.68; 95% CI, 0.49 to 0.94), and hypoglycemia (HR, 0.23; 95% CI, 0.08 to 0.71), after accounting for major confounding factors. Conclusions: In T2D treatment, the use of acarbose as an add-on remedy to metformin was associated with lower risks of major atherosclerotic events, ischemic stroke, and hypoglycemia compared with the use of sulfonylurea as an add-on remedy. (J Clin Endocrinol Metab 103: 3611-3619, 2018).

Original languageEnglish
Pages (from-to)3611-3619
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Issue number10
StatePublished - 1 Oct 2018


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