Acarbose confers hepato-, cardioprotection in T2D patients with end-stage renal disease

Acarbose may be safely used in type 2 diabetes (T2D) patients with comorbid renal diseases, with real-world data showing that the glucose-lowering drug reduces the risks of hepatic injury, cardiovascular diseases, and all-cause mortality.

The study used data from Taiwan’s National Health Insurance Research Database and included 32,531 T2D patients (mean age at dialysis, 63.53 years; average diabetes duration at dialysis, 5.50 years) with end-stage renal disease (ESRD).

CVDs were the most prevalent comorbidities (55.46 percent), followed by retinopathy (43.78 percent) and neuropathy (25.58 percent). The most frequently prescribed glucose-lowering drug at 1 year before or at the index date was sulfonylureas (52.22 percent), followed by insulin (48.90 percent) and meglitinides (28.55 percent).

Acarbose was initiated in 19.3 percent of patients during follow-up (from 2000–2012 to 2013). Use of this drug was quantified as the numbers of the 30-day drug’s supplies and dosages (measured by defined daily doses [DDDs]), respectively.

Each 30-day supply increase in acarbose exposure yielded reductions of 9 percent in the risk of hepatic injury, 7 percent in the risk of composite CVD events, and another 7 percent in the risk of all-cause mortality. Meanwhile, for each 30-day DDD increase in acarbose exposure, the risks of the three outcomes were further decreased by 45 percent, 33 percent, and 35 percent, respectively.

In subgroup analyses, the hepatic and cardiovascular benefits of acarbose use were more pronounced in patients with more severe diabetes, a longer diabetes duration, or absence of established CVD at baseline.

Larger studies with longer-term follow-ups are warranted to establish the rational and safe use of glucose-lowering drugs in the subgroup of T2D patients with comorbid renal diseases.