Voglibose, in addition to lifestyle modification, reduces the development of type 2 diabetes in high-risk Japanese people. The findings are reported in an Article published Online First and in an upcoming edition of The Lancet, written by Professor Ryuzo Kawamori, Juntendo University School of Medicine, Tokyo, Japan, and colleagues.
Voglibose is an α-glucosidase inhibitor, which works by reducing the amount of glucose absorbed into the bloodstream. In this randomised trial, 1780 eligible patients were randomly assigned to oral voglibose 0.2 mg three times a day (897 patients) or placebo (883). These patients were on a standard diet and taking regular exercise, and had impaired glucose tolerance but not full-blown diabetes. Treatment was continued until participants developed type 2 diabetes (primary endpoint), or normal blood sugar control (normoglycaemia - secondary endpoint), or for a minimum of three years, subject to the findings of an interim analysis.
The researchers found that in the interim analysis (mean treatment period just under 1 year) voglibose was much better than placebo. Patients treated with voglibose had a 40% lower risk of progression to type 2 diabetes than those receiving placebo; and patients given voglibose were 54% more likely to achieve normoglycaemia than those given placebo. 48% of patients in the voglibose group had adverse events possibly or probably related to treatment, versus 29% of the placebo group. A small number of serious adverse events were reported in both groups. In the voglibose group, these were one each of gall bladder inflammation, colonic polyp, rectal tumour, inguinal hernia, liver dysfunction, and brain haemorrhage; and in the placebo group one blockage of brain blood-flow and one gall-bladder inflammation.
The authors conclude: "Voglibose significantly improved glucose tolerance, in terms of delayed disease progression and in the number of patients who achieved normoglycaemia. Thus, long-term prophylaxis with this α-glucosidase inhibitor in high-risk individuals with impaired glucose tolerance could provide a pharmacological option, along with lifestyle modification, to help reduce the burden of type 2 diabetes in Japan."
In an accompanying Comment, Dr André J Scheen, Division of Diabetes, Department of Medicine, University of Liège, Belgium, says: "[This] study showed that, if best efforts to educate individuals do not work, treatment with voglibose could be an important way forward." He also speculates that the results could be transferable to other populations, because they agree with results reported in a similar trial involving European and Canadian patients.
Professor Ryuzo Kawamori, Juntendo University School of Medicine, Tokyo, Japan T) +81-3-5802-1578 E) kawamori@juntendo.ac.jp
Dr André J Scheen, Division of Diabetes, Department of Medicine, University of Liège, Belgium contact by e-mail E) andre.scheen@chu.ulg.ac.be
For full Article and Comment, see: http://press.thelancet.com/voglibosefinal.pdf
Journal
The Lancet