Differential Responses to Acarbose Between Obese and Non-obese Patients with Type 2 Diabetes Mellitus

To investigate the responses in terms of body weight, glycemic control, metabolic control, and the side effects to acarbose add-on therapy in obese and non-obese type 2 diabetes patients with inadequately controlled by sulfonylureas and metformin. Materials and Methods: Forty obese (BMI >= 27) and 80 sex-and age-matched non-obese patients with type 2 diabetes mellitus were enrolled in this 3-month, open-label, case-controlled trial for acarbose add-on therapy. Totally 111 (73 non-obese and 38 obese) patients completed 3-month acarbose add-on therapy. This study adopted a 2-center open-label parallel group design. After a 4-week run-in period, acarbose was added (titrated up to 100 mg t.i.d.) to the current sulfonylureas and metformin combined therapy of subjects. Both obese patients (9.3 +/- 1.3% vs. 8.3 +/- 1.6%, p < 0.0001) and non-obese patients (9.4 +/- 1.2% vs. 8.4 +/- 1.2%, p < 0.0001) showed decreased HbA1c after therapy. While obese patients showed a significant serum alanine aminotransferase (ALT) (61 +/- 26 vs. 49 +/- 18, p < 0.0001) and triglyceride reduction (242 +/- 127 vs. 187 +/- 71, p < 0.01) after add-on therapy, non-obese patients did not. Neither obese (74.8 +/- 9.2 vs. 74.4 +/- 9.8 kg, N.S.) nor non-obese patients (61.9 +/- 7.9 vs. 61.6 +/- 7.7 kg, p = 0.0579) show significant decrease in body weight. Conclusion: Both obese patients and non-obese patients showed decreased HbA1c after acarbose therapy. Obese patients had an additional benefit of a decrease in their previoulsly elevated ALT and triglyceride levels after acarbose therapy.