Cardiovascular Benefits of Acarbose vs Sulfonylureas in Patients With Type 2 Diabetes Treated With Metformin

J Clin Endocrinol Metab. 2018 Oct 1;103(10):3611-3619. doi: 10.1210/jc.2018-00040.


Context: Although α-glucosidase inhibitors (AGIs) have been shown to reduce the risk of myocardial infarction in patients with impaired glucose tolerance, the cardiovascular benefits of AGIs in those with type 2 diabetes (T2D) remains unclear.

Objective: We compared the clinical outcomes of adding acarbose vs sulfonylureas to metformin therapy in patients with T2D.

Design, setting, and participants: The study population was drawn from the database of the Diabetes Pay-for-Performance program in Taiwan. Sulfonylureas and acarbose were prescribed to 196,143 and 14,306 patients with T2D, respectively, from 2004 to 2015, who had been treated with metformin. A propensity score-matched cohort study was conducted. The patients were followed up for clinical adverse events of all-cause mortality and hospitalizations of major atherosclerotic events (i.e., myocardial infarction and ischemic stroke), heart failure, or hypoglycemia.

Results: A total of 14,306 propensity score-matched pairs (age, 55.8 ± 13.1 years; 47.8% men) were enrolled in the present analysis. Compared with sulfonylureas as the add-on therapy to metformin, the use of acarbose was associated with significantly lower risks of hospitalizations for major atherosclerotic events [hazard ratio (HR), 0.69; 95% CI, 0.52 to 0.91], ischemic stroke (HR, 0.68; 95% CI, 0.49 to 0.94), and hypoglycemia (HR, 0.23; 95% CI, 0.08 to 0.71), after accounting for major confounding factors.

Conclusions: In T2D treatment, the use of acarbose as an add-on remedy to metformin was associated with lower risks of major atherosclerotic events, ischemic stroke, and hypoglycemia compared with the use of sulfonylurea as an add-on remedy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acarbose / therapeutic use*
  • Adult
  • Aged
  • Biomarkers / analysis
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / drug therapy*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / pathology
  • Female
  • Follow-Up Studies
  • Glycoside Hydrolase Inhibitors / therapeutic use*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Male
  • Metformin / adverse effects*
  • Middle Aged
  • Prognosis
  • Propensity Score
  • Risk Factors
  • Sulfonylurea Compounds / therapeutic use*
  • Survival Rate
  • Taiwan
  • Young Adult


  • Biomarkers
  • Glycoside Hydrolase Inhibitors
  • Hypoglycemic Agents
  • Sulfonylurea Compounds
  • Metformin
  • Acarbose