The worldwide increase in type-2 diabetes (the onset of diabetes in middle/old age due to impaired insulin production) is becoming a major health concern. Jean-Louis Chiasson from the University of Montreal, Canada, and colleagues aimed to assess the effect of the drug acarbose in preventing or delaying conversion of impaired glucose tolerance to type-2 diabetes.

Around 1400 patients from Canada, Germany, Austria, Norway, Denmark, Sweden, Finland, Israel, and Spain with impaired glucose tolerance were randomly assigned 100 mg acarbose or placebo three times daily. The primary endpoint was the development of diabetes on the basis of a yearly oral glucose tolerance test.

31% of patients given acarbose and 19% of patients given placebo discontinued treatment early. 10% fewer patients given acarbose developed diabetes (32% compared with 42%, respectively)a relative reduction in risk of 25%. Furthermore, acarbose significantly increased reversion of impaired glucose tolerance to normal glucose tolerance. The main side effects of acarbose were flatulence and diarrhoea.

Jean-Louis Chiasson comments: "Lifestyle modification has already been shown to prevent type-2 diabetes. Our results show that intervention with acarbose is also effective. Whether these two treatment options can be used together remains to be determined. Nevertheless, recommendations for screening and treatment of impaired glucose tolerance should now be reassessed."

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Lancet
13-Jun-2002