Evaluation of the Effects of Acarbose on Weight and Metabolic, Inflammatory, and Cardiovascular Markers in Patients with Obesity and Overweight

Noushin Khalili, Alireza Safavipour

Abstract


Background: Metabolic syndrome (MetS) refers to a cluster of risk factors for cardiovascular disease and type 2 diabetes. The aim of this study is to assess the effects of acarbose as an antihyperglycemic agent (drug) on late complications of MetS.

Methods: This double‑blind randomized clinical trial was done on patients with MetS admitted to Isfahan Endocrine and Metabolism Research Center. They were assigned randomly to two groups: A who received acarbose (n = 32) and group B who received a placebo (n = 42) for 6 months. Cardiovascular indexes including flow‑mediated dilation (FMD), intima‑media thickness (IMT), epicardial fat thickness (EFT), and C‑reactive protein (CRP) were measured at baseline and 6 months after the treatment and compared between the two groups.

Results: Post‑intervention mean of weight (mean difference: −2.5 ± 0.89) and abdominal obesity (mean difference: −2.2 ± 0.64) in acarbose group were significantly decreased (P value < 0.001). High‑density lipoprotein (HDL) level in acarbose group was significantly higher than control group (44.7 ± 7.6 vs 41.1 ± 6.4; P value = 0.043), while the other metabolic parameters were not significantly different between the two groups (P value > 0.05). In both groups, CRP and EFT decreased significantly after the intervention, and the levels of CRP, EFT, and IMT markers in the acarbose group were significantly lower than control group (P value < 0.05).

Conclusions: The administration of acarbose in patients with MetS can decrease weight and abdominal obesity as well as the reduction of inflammatory and cardiovascular markers, including CRP, EFT, and IMT and also increases HDL.


Keywords


Acarbose; cardiovascular; C-reactive protein; inflammatory marker; metabolic syndrome; obesity

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References


Limberg JK, Morgan BJ, Schrage WG. Peripheral blood flow

regulation in human obesity and metabolic syndrome. Exerc

Sport Sci Rev 2016;44:116‑22.

Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT,

Fonseca VA, Garber AJ, et al. American association of clinical

endocrinologists and American college of endocrinology

guidelines for management of dyslipidemia and prevention of

cardiovascular disease. Endocr Pract 2017;23(Suppl 2):1‑87.

Han TS, Lean ME. A clinical perspective of obesity, metabolic

syndrome and cardiovascular disease. JRSM Cardiovasc Dis

;5:2048004016633371.

Verma P, Srivastava RK, Jain D. Association of lifestyle risk

factors with metabolic syndrome components: A cross‑sectional

study in Eastern India. Int J Prev Med 2018;9:6.

Lau DC, Yan H, Dhillon B. Metabolic syndrome: A marker

of patients at high cardiovascular risk. Can J Cardiol

;22:85B‑90B.

Esser N, L’Homme L, De Roover A, Kohnen L, Scheen AJ,

Moutschen M, et al. Obesity phenotype is related to NLRP3

inflammasome activity and immunological profile of visceral

adipose tissue. Diabetologia 2013;56:2487‑97.

Yamagishi S. Cardiovascular disease in recent onset diabetes

mellitus. J Cardiol 2011;57:257‑62.

Agrawal NK, Kant S. Targeting inflammation in diabetes: Newer

therapeutic options. World J Diabetes 2014;5:697‑710.

Ceriello A, Giacomello R, Stel G, Motz E, Taboga C, Tonutti L,

et al. Hyperglycemia‑induced thrombin formation in diabetes:

The possible role of oxidative stress. Diabetes 1995;44:924‑8.

Esser N, Paquot N, Scheen AJ. Anti‑inflammatory agents to treat

or prevent type 2 diabetes, metabolic syndrome and cardiovascular

disease. Expert Opin Investig Drugs 2015;24:283‑307.

Younk LM, Lamos EM, Davis SN. Cardiovascular effects of antidiabetes drugs. Expert Opinion on Drug Safety 2016;15:1239-57.

Singla RK, Singh R, Dubey AK. Important aspects of

post‑prandial antidiabetic drug, acarbose. Curr Top Med Chem

;16:65‑70.

Yamagishi S, Nakamura K, Takeuchi M. Inhibition of

postprandial hyperglycemia by acarbose is a promising

therapeutic strategy for the treatment of patients with the

metabolic syndrome. Med Hypotheses 2005;65:152‑4.

Tsai SS, Chu YY, Chen ST, Chu PH. A comparison of different

definitions of metabolic syndrome for the risks of atherosclerosis

and diabetes. Diabetol Metab Syndr 2018;10:5613.

Ghobadi S, Rostami ZH, Marzijarani MS, Faghih S. Association

of vitamin D status and metabolic syndrome components in

Iranian children. Int J Prev Med 2019;10:77.

Di Nicolantonio JJ, Bhutani J, O’Keefe JH. Acarbose: Safe

and effective for lowering postprandial hyperglycaemia and

improving cardiovascular outcomes. Open Heart 2015;2:e000327.

Nakhaee A, Sanjari M. Evaluation of effect of acarbose

consumption on weight losing in non‑diabetic overweight or

obese patients in Kerman. J Res Med Sci 2013;18:391.

Schnell O, Weng J, Sheu WH, Watada H, Kalra S, Soegondo S,

et al. Acarbose reduces body weight irrespective of glycemic

control in patients with diabetes: Results of a worldwide,

non‑interventional, observational study data pool. J Diabetes

Complications 2016;30:628‑37.

Foretz M, Guigas B, Bertrand L, Pollak M, Viollet M.

Metformin: From mechanisms of action to therapies. Cell Metab

;20:953‑66.

Grahame Hardie D. AMP‑activated protein kinase: A key

regulator of energy balance with many roles in human disease.

J Intern Med 2014;276:543‑59.

Rakel A, Renier G, Roussin A, Buithieu J, Mamputu JC, Serri O.

Beneficial effects of gliclazide modified release compared

with glibenclamide on endothelial activation and low grade

inflammation in patients with type 2 diabetes. Diabetes Obes

Metab 2007;9:127‑9.

Nicholls SJ, Tuzcu EM, Wolski K, Bayturan O, Lavoie A,

Uno K, et al. Lowering the triglyceride/high‑density lipoprotein

cholesterol ratio is associated with the beneficial impact of

pioglitazone on progression of coronary atherosclerosis in diabetic

patients: Insights from the PERISCOPE (Pioglitazone Effect on

Regression of Intravascular Sonographic Coronary Obstruction

Prospective Evaluation) Study. J Am Coll Cardiol 2011;57:153‑9.

Tung D, Cheung PH, Ciallella J, Saha S. Novel anti inflammatory

effects of repaglinide in rodent models of inflammation.

Pharmacology 2011;88:295‑301.

Scheen AJ, Esser N, Paquot N. Antidiabetic agents: Potential anti

inflammatory activity beyond glucose control. Diabetes Metab

;41:183‑94.

Rudovich N, Weickert MO, Pivovarova O, Bernigau W,

Pfeiffer AF. Effects of acarbose treatment on markers of insulin

sensitivity and systemic inflammation. Diabetes Technol Ther

;13:615‑23.

Derosa G, Maffioli P, Ferrari I, Fogari E, D’Angelo A,

Palumbo I, et al. Acarbose actions on insulin resistance and

inflammatory parameters during an oral fat load. Eur J Pharmacol

;651:240‑50