scholarly journals Impact of Acarbose on Incident Diabetes and Regression to Normoglycemia in People with Coronary Heart Disease and Impaired Glucose Tolerance: Insights from the ACE Trial

2020 ◽  
Author(s):  
Hertzel C. Gerstein ◽  
Ruth L. Coleman ◽  
Charles A.B. Scott ◽  
Shishi Xu ◽  
Jaakko Tuomilehto ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Multiple Testing ◽  
Angiotensin Receptor Blockers ◽  
Incident Diabetes ◽  
Channel Blockers ◽  
Cardiovascular Evaluation ◽  
The Impact

OBJECTIVE <p>We examined the impact of acarbose, an alpha-glucosidase inhibitor, on incident diabetes and regression to normoglycemia in 6,522 Acarbose Cardiovascular Evaluation trial participants in China who had impaired glucose tolerance (IGT) and coronary heart disease (CHD).</p> <p>RESEARCH DESIGN AND METHODS</p> <p>Participants were randomly assigned to acarbose or placebo and followed with four-monthly FPGs and annual OGTTs. Incident diabetes was defined as two successive diagnostic FPGs ≥ 7 mmol/L or 2-hr PGs ≥ 11.1 mmol /L while taking study medication, or a masked adjudicated confirmation of this diagnosis. Regression to normoglycemia was defined as FPG <6.1 mmol/L and 2-hr PG <7.8 mmol/L. Intention-to-treat and on-treatment analyses were conducted using Poisson regression models, overall and for subgroups (age, sex, CHD type, HbA<sub>1c</sub>, FPG, 2h-PG, BMI eGFR), for IGT alone and for IGT+IFG, and for use of thiazides, ACE inhibitors/angiotensin receptor blockers, beta blockers, calcium channel blockers or statins). </p> <p>RESULTS</p> <p>Incident diabetes was less frequent with acarbose, compared with placebo, being 3.2 and 3.8 <i>per</i> 100 person-years respectively (rate ratio (RR) 0.82, 95%CI 0.71–0.94, p=0.005), with no evidence of differential effects within the predefined subgroups after accounting for multiple testing. Regression to normoglycemia occurred more frequently in those randomized to acarbose, compared with placebo, being 16.3 and 14.1 <i>per</i> 100 person-years respectively (RR 1.16, 95%CI 1.08–1.25, p<0.0001). This effect was greater in participants not taking an ACEi or ARB (RR 1.36, 95%CI 1.21–1.53; P<sub>interaction</sub>=0.0006). The likelihood of remaining in normoglycemic regression did not differ between acarbose and placebo groups (P=0.41).</p> <p>CONCLUSIONS</p> <p>Acarbose reduced the incidence of diabetes and promoted regression to normoglycemia in Chinese people with IGT and CHD. </p>

scholarly journals Impact of Acarbose on Incident Diabetes and Regression to Normoglycemia in People with Coronary Heart Disease and Impaired Glucose Tolerance: Insights from the ACE Trial

2020 ◽  
Author(s):  
Hertzel C. Gerstein ◽  
Ruth L. Coleman ◽  
Charles A.B. Scott ◽  
Shishi Xu ◽  
Jaakko Tuomilehto ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Multiple Testing ◽  
Angiotensin Receptor Blockers ◽  
Incident Diabetes ◽  
Channel Blockers ◽  
Cardiovascular Evaluation ◽  
The Impact

OBJECTIVE <p>We examined the impact of acarbose, an alpha-glucosidase inhibitor, on incident diabetes and regression to normoglycemia in 6,522 Acarbose Cardiovascular Evaluation trial participants in China who had impaired glucose tolerance (IGT) and coronary heart disease (CHD).</p> <p>RESEARCH DESIGN AND METHODS</p> <p>Participants were randomly assigned to acarbose or placebo and followed with four-monthly FPGs and annual OGTTs. Incident diabetes was defined as two successive diagnostic FPGs ≥ 7 mmol/L or 2-hr PGs ≥ 11.1 mmol /L while taking study medication, or a masked adjudicated confirmation of this diagnosis. Regression to normoglycemia was defined as FPG <6.1 mmol/L and 2-hr PG <7.8 mmol/L. Intention-to-treat and on-treatment analyses were conducted using Poisson regression models, overall and for subgroups (age, sex, CHD type, HbA<sub>1c</sub>, FPG, 2h-PG, BMI eGFR), for IGT alone and for IGT+IFG, and for use of thiazides, ACE inhibitors/angiotensin receptor blockers, beta blockers, calcium channel blockers or statins). </p> <p>RESULTS</p> <p>Incident diabetes was less frequent with acarbose, compared with placebo, being 3.2 and 3.8 <i>per</i> 100 person-years respectively (rate ratio (RR) 0.82, 95%CI 0.71–0.94, p=0.005), with no evidence of differential effects within the predefined subgroups after accounting for multiple testing. Regression to normoglycemia occurred more frequently in those randomized to acarbose, compared with placebo, being 16.3 and 14.1 <i>per</i> 100 person-years respectively (RR 1.16, 95%CI 1.08–1.25, p<0.0001). This effect was greater in participants not taking an ACEi or ARB (RR 1.36, 95%CI 1.21–1.53; P<sub>interaction</sub>=0.0006). The likelihood of remaining in normoglycemic regression did not differ between acarbose and placebo groups (P=0.41).</p> <p>CONCLUSIONS</p> <p>Acarbose reduced the incidence of diabetes and promoted regression to normoglycemia in Chinese people with IGT and CHD. </p>

Predicting Heart Failure Events in Patients with Coronary Heart Disease and Impaired Glucose Tolerance: Insights from the Acarbose Cardiovascular Evaluation (ACE) Trial

2020 ◽  
Author(s):  
Malgorzata Wamil ◽  
John J. V. McMurray ◽  
Charles A.B. Scott ◽  
Ruth L. Coleman ◽  
Yihong Sun ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Plasma Creatinine ◽  
Cardiovascular Evaluation

Abstract BACKGROUND Heart failure is a fatal complication of type 2 diabetes but little is known about its incidence in patients with impaired glucose tolerance (IGT). We used Acarbose Cardiovascular Evaluation (ACE) trial data to identify predictors of hospitalisation for heart failure (hHF) or cardiovascular (CV) death in patients with coronary heart disease (CHD) and IGT randomized to acarbose 50mg TID or placebo. METHODS Independent hHF or hHF/CV death risk factors were determined using Cox proportional hazards models, with participants censored at first hHF event, CV death, or end of follow-up. Baseline variables evaluated included age, sex, body mass index, smoking, plasma creatinine, prior CV events, fasting and 2-hour post-load glucose, and HbA1c. Those with nominal univariate associations (P<0.1) were entered into a multivariate model, with P<0.05 required for retention. Recurrent hHF events were analysed using the Andersen-Gill model, a generalisation of the Cox proportional hazards model, and logistic regression was used for death following hHF. RESULTS During median 5 years follow-up, hHF/CV death occurred in 393 (6.0%) ACE participants (triggered by 138 hHF events and 255 CV deaths). Significant hHF/CV death multivariate predictors were higher age and plasma creatinine, as well as prior heart failure (HF), myocardial infarction (MI), atrial fibrillation (AF) and stroke. Acarbose, compared with placebo, did not reduce hHF/CV death (hazard ratio [HR] 0.89, 95% CI 0.64–1.24, P=0.48) or hHF (HR 0.90, 95% CI 0.74–1.10, P=0.32). Forty of the 138 participants who experienced hHF had ³2 admissions, and 58 died. No significant effect of acarbose, compared with placebo, was seen for recurrent hHF (HR 1.19, 95% CI 0.92-1.55, p=0.19), or for all-cause mortality (odds ratio 1.49, 95% CI 0.75-2.95, p=0.25).CONCLUSIONS Patients with CHD and IGT at greater risk of hHF/CV death were older with higher plasma creatinine, and had prior HF, MI, AF or stroke. Addition of acarbose to optimized CV therapy did not reduce the risk of hHF/CV death or hHF. Clinical Trial Registration: ClinicalTrials.gov, number NCT00829660, and the International Standard Randomised Controlled Trial Number registry, number ISRCTN91899513.

scholarly journals Impact of Acarbose on Incident Diabetes and Regression to Normoglycemia in People With Coronary Heart Disease and Impaired Glucose Tolerance: Insights From the ACE Trial

Diabetes Care ◽  
2020 ◽  
Vol 43 (9) ◽  
pp. 2242-2247
Author(s):  
Hertzel C. Gerstein ◽  
Ruth L. Coleman ◽  
Charles A.B. Scott ◽  
Shishi Xu ◽  
Jaakko Tuomilehto ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Incident Diabetes

2436-PUB: Predicting Risk for New-Onset Type 2 Diabetes in Chinese People with Coronary Heart Disease and Impaired Glucose Tolerance

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 2436-PUB
Author(s):  
SHISHI XU ◽  
CHARLES A. SCOTT ◽  
RUTH L. COLEMAN ◽  
JAAKKO TUOMILEHTO ◽  
RURY R. HOLMAN
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Chinese People ◽  
Onset Type ◽  
New Onset

Sex-specific clinical outcomes of impaired glucose status: A long follow-up from the Tehran Lipid and Glucose Study

2019 ◽  
Vol 26 (10) ◽  
pp. 1080-1091 ◽  
Author(s):  
Donna Parizadeh ◽  
Neda Rahimian ◽  
Samaneh Akbarpour ◽  
Fereidoun Azizi ◽  
Farzad Hadaegh
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Kidney Disease ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Plasma Glucose ◽  
Hazard Ratio

Aims To investigate the sex-specific associations of prediabetes with major clinical outcomes including incident type 2 diabetes, chronic kidney disease, hypertension, coronary heart disease, stroke and all-cause mortality. Methods Among 8498 Iranian adults from the Tehran Lipid and Glucose Study, aged ≥30 years and without diagnosed type 2 diabetes, gender-interactions were assessed for each outcome, followed by sex-separated multivariate-adjusted Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals (CIs) of different prediabetes categories, including impaired fasting glucose (IFG), defined by the American Diabetes Association (ADA) and World Health Organization (WHO), as fasting plasma glucose of 5.6–6.9 mmol/L and 6.1–6.9 mmol/L, respectively, and impaired glucose tolerance, defined as 2-h post challenge plasma glucose of 7.8–11 mmol/L. Results Sex-specific associations existed for men between IFG-ADA and chronic kidney disease (hazard ratio: 1.28, 95% CI 0.99–1.65; pinteraction = 0.008) and between IFG-WHO and stroke (hazard ratio: 2.15, 95% CI 1.08–4.27; pinteraction = 0.21); and for women between IFG-ADA and hypertension (hazard ratio: 1.24, 95% CI 1.04–1.48; pinteraction = 0.06) and between impaired glucose tolerance and coronary heart disease (hazard ratio: 1.57, 95% CI 1.14–2.16; pinteraction = 0.05). Among both genders, all prediabetes definitions were associated with type 2 diabetes but none with mortality. Conclusions The hazards of prediabetes definitions may differ between genders depending on the outcome of interest. IFG-WHO among men and impaired glucose tolerance among women are particularly important because of their association with incident stroke and coronary heart disease, respectively. Considering these sex differences could improve personalized management of prediabetes.

scholarly journals Sex-specific Prevalence of coronary heart disease among Tehranian adult population across different glycemic status: Tehran Lipid and Glucose Study, 2008-2011

2020 ◽  
Author(s):  
Seyyed Saeed Moazzeni ◽  
Hamidreza Ghafelehbashi ◽  
Mitra Hasheminia ◽  
Donna Parizadeh ◽  
Arash Ghanbarian ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Diabetic Patients ◽  
Glycemic Status ◽  
Adjusted Model

Abstract Background: Coronary heart disease (CHD) is one of the main causes of deaths. Alarmingly Iranian populations had a high rank of CHD worldwide. The current study aimed to assess the prevalence of CHD across different glycemic categories. Methods: This study was conducted on 7,718 Tehranian participants (Men=3427) aged ≥ 30 years from 2008 to 2011. They were categorized based on glycemic status. The prevalence of CHD was calculated in each group, separately. CHD was defined as hospital records adjudicated by an outcome committee. The association of different glycemic categories with CHD was calculated using multivariate logistic regression, compared with normal fasting glucose /normal glucose tolerance (NFG/NGT) group as reference. Results: The age-standardized prevalence of isolated impaired fasting glucose (iIFG), isolated impaired glucose tolerance (iIGT), both impaired fasting glucose and impaired glucose tolerance (IFG/IGT), newly diagnosed diabetes mellitus (NDM), and known diabetes mellitus (KDM) were 14.30% [95% confidence interval (CI): 13.50-15.09], 4.81% [4.32-5.29], 5.19% [4.71-5.67], 5.79% [5.29-6.28] and 7.72% [7.17-8.27], respectively. Among a total of 750 individuals diagnosed as cases of CHD (398 in men), 117 (15.6%), 453 (60.4%), and 317 (42.3%) had history of myocardial infarction (MI), cardiac procedure, and unstable angina, respectively. The age-standardized prevalence of CHD for Tehranian population was 7.71% [7.18-8.24] in total population, 8.62 [7.81-9.44] in men and 7.19 [6.46-7.93] in women. Moreover, among diabetic participants, the age-standardized prevalence of CHD were 13.10 [9.83-16.38] in men 10.67 [8.90-12.44] in women, respectively, which were significantly higher than corresponding values for NFG/NGT and prediabetic groups. Across 6 levels of glycemic status, CHD was associated with IFG/IGT [ odds ratio (OR) and 95% CI: 1.38 (1.01-1.89)], NDM [1.83 (1.40-2.41)], and KDM [2.83 (2.26-3.55)] groups, in the age and sex adjusted model. Furthermore, in the full-adjusted model, only NDM and KDM status remained to be associated with the presence of CHD by ORs of 1.40 (1.06-1.85) for NDM and 1.90 (1.50-2.41) for KDM. Conclusion: The high prevalence of CHD, especially among diabetic populations, necessitates urgent implementation of behavioral interventions among Tehranian population, according to evidence-based guidelines for the clinical management of diabetic patients.

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