Endocrine Abstracts

Introduction: Although alpha-glucosidase inhibitors (aGIs), including acarbose, are recommended in several international guidelines, they are not widely used worldwide due to a perception that they are less effective in Caucasians than Asians. A study was undertaken to investigate whether differences between ethnicity/region populations exist.

Methods/design: We pooled data from 10 non-interventional and post-marketing studies from 21 countries, provinces and country groups from the launch of acarbose to 2011. The effects of acarbose on glycosylated hemoglobin (HbA_1c), fasting plasma glucose (FPG) and post-prandial plasma glucose (PPG) were analyzed for four major ethnicity/region groups: Caucasians from Europe and Asians from East, South East and South Asia.

Results: The efficacy population included 62,905 patients, with 59,090 patients from the four groups of interest. At the 3-month visit, mean HbA_1c had decreased by −1.12±1.31% from 8.4% at baseline (n=32,692), FPG by 37.59±47.26 mg/dl from 170.2 mg/dl (n=45,102), and PPG by 70.00±65.30 mg/dl from 238.2 mg/dl (n=43,290) (P<0.0001 for all comparisons). Reductions in HbA_1c, FPG and PPG were larger in patients with higher baseline values regardless of ethnicity and region. Data from 30,730 patients from the four groups with non-missing baseline and 3-month HbA_1c data, age and sex were analyzed by multivariable ANCOVA. After adjustment for relevant baseline confounding factors, South East and East Asians had slightly better responses to acarbose than South Asians and European Caucasians; however, the differences were numerically small (e.g. relative difference of ~2.2% for baseline HbA_1c of 7.2%; ~3.4% for baseline HbA_1c of 9.2%). In the safety population (n=67,682), acarbose was well tolerated, with few episodes of hypoglycemia (0.03%) and gastrointestinal adverse events (2.76%).

Conclusion: Acarbose was effective in European Caucasians and Asians; however, after adjustment for baseline confounding factors, South East and East Asians had slightly better responses to acarbose than South Asians and European Caucasians.