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Comparison of Glucose Lowering Effect of Metformin and Acarbose in Type 2 Diabetes Mellitus: A Meta-Analysis

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  • Shuyan Gu
  • Jihao Shi
  • Zhiliu Tang
  • Monika Sawhney
  • Huimei Hu
  • Lizheng Shi
  • Vivian Fonseca
  • Hengjin Dong

Abstract

Background: Metformin is the first-line oral hypoglycemic agent for type 2 diabetes mellitus recommended by international guidelines. However, little information exists comparing it with acarbose which is also commonly used in China. This study expanded knowledge by combining direct and indirect evidence to ascertain the glucose lowering effects of both drugs. Methods: PubMed (1980- December 2013) and China National Knowledge Infrastructure databases (1994-January 2014) were systematically searched for eligible randomized controlled trials from Chinese and English literatures. Meta-analysis was conducted to estimate the glucose lowering effects of metformin vs. acarbose, or either of them vs. common comparators (placebo or sulphonylureas), using random- and fixed-effect models. Bucher method with indirect treatment comparison calculator was applied to convert the summary estimates from the meta-analyses into weighted-mean-difference (WMD) and 95% confidence intervals (CIs) to represent the comparative efficacy between metformin and acarbose. Results: A total of 75 studies were included in the analysis. In direct comparison (8 trials), metformin reduced glycosylated hemoglobin (HbA1c) by 0.06% more than acarbose, with no significant difference (WMD,-0.06%; 95% CI, -0.32% to 0.20%). In indirect comparisons (67 trials), by using placebo and sulphonylureas as common comparators, metformin achieved significant HbA1c reduction than acarbose, by -0.38% (WMD,-0.38%, 95% CI, -0.736% to -0.024%) and -0.34% (WMD, -0.34%, 95% CI, -0.651% to -0.029%) respectively. Conclusion: The glucose lowering effects of metformin monotherapy and acarbose monotherapy are the same by direct comparison, while metformin is a little better by indirect comparison. This implies that the effect of metformin is at least as good as acarbose's.

Suggested Citation

  • Shuyan Gu & Jihao Shi & Zhiliu Tang & Monika Sawhney & Huimei Hu & Lizheng Shi & Vivian Fonseca & Hengjin Dong, 2015. "Comparison of Glucose Lowering Effect of Metformin and Acarbose in Type 2 Diabetes Mellitus: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-22, May.
    • Handle: RePEc:plo:pone00:0126704
    DOI: 10.1371/journal.pone.0126704
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    References listed on IDEAS

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    1. Sarah Donegan & Paula Williamson & Carrol Gamble & Catrin Tudur-Smith, 2010. "Indirect Comparisons: A Review of Reporting and Methodological Quality," PLOS ONE, Public Library of Science, vol. 5(11), pages 1-11, November.
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    1. Shuyan Gu & Yiming Mu & Suodi Zhai & Yuhang Zeng & Xuemei Zhen & Hengjin Dong, 2016. "Cost-Effectiveness of Dapagliflozin versus Acarbose as a Monotherapy in Type 2 Diabetes in China," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-25, November.
    2. Jung-Ha Sung & Jung-Min Lee & Jung-Hyun Kim, 2022. "The Effectiveness of Ultrasound Deep Heat Therapy for Adhesive Capsulitis: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 19(3), pages 1-12, February.

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