Glycemic excursions are positively associated with HbA1c reduction from baseline after treatment with acarbose in patients with type 2 diabetes on metformin monotherapy

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The aim of the present study was to examine the association between glycemic excursions before treatment and HbA1c reduction after treatment intensification with acarbose or glibenclamide in patients with type 2 diabetes (T2D).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients receiving single or dual oral antidiabetic drug treatment with an HbA1c of 7.0–11.0 % (53–97 mmol/mol) were switched to metformin monotherapy (500 mg, t.i.d.) for 8 weeks, followed by randomization to either acarbose (100 mg, t.i.d.) or glibenclamide (5 mg, t.i.d.) as add‐on treatment for 16 weeks. Glycemic excursions were assessed as mean amplitude of glycemic excursions (MAGE) with 72‐h ambulatory continuous glucose monitoring. Treatment efficacy was evaluated as relative HbA1c reduction (%), calculated as (baseline HbA1c – post‐treatment HbA1c)/baseline HbA1c × 100.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Fifty patients (mean [±SD] age 53.5 ± 8.2 years, 48 % men, mean baseline HbA1c 8.4 ± 1.2 %) were analyzed. Baseline MAGE was positively correlated with relative HbA1c reduction from baseline in patients treated with acarbose (<jats:italic>r</jats:italic> = 0.421, <jats:italic>P</jats:italic> = 0.029) but not glibenclamide (<jats:italic>r</jats:italic> = 0.052, <jats:italic>P</jats:italic> = 0.813). Linear regression analysis revealed that the association between baseline MAGE and relative HbA1c reduction from baseline (β = 0.125, <jats:italic>P</jats:italic> = 0.029) in patients treated with acarbose remained significant after adjustment for several confounders (<jats:italic>P</jats:italic> < 0.05 for all models).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In patients with T2D on metformin monotherapy, baseline MAGE was positively correlated with relative HbA1c reduction from baseline after treatment with acarbose, but not glibenclamide. These findings highlight the importance of glycemic excursions in individualized treatment for patients with T2D.</jats:p></jats:sec>