Treatment of impaired glucose tolerance with acarbose and its effect on intima-media thickness: a substudy of the STOP-NIDDM trial (study to prevent non-insulin-dependent diabetes mellitus).

To discuss the influence of glucose excursions on intima-media thickness (IMT) and the potential benefits of treatment to reduce or reverse its effects on cardiovascular risk. The findings in pertinent reported studies are reviewed, and the efficacy of various interventions for management of impaired glucose tolerance and type 2 diabetes in slowing the progression of IMT is analyzed. Considerable evidence from published epidemiologic studies provides compelling data regarding the association between postprandial and postchallenge glycemic excursions and cardiovascular risk. IMT has been shown to be a good surrogate marker for symptomatic and coronary atherosclerosis. Acarbose treatment in patients with impaired glucose tolerance has been shown to diminish the progression of IMT in comparison with placebo. In a study of repaglinide or glyburide therapy in patients with type 2 diabetes, a reduction in IMT was noted in the repaglinide group but not in the glyburide group at 1-year follow-up. Measurement of IMT allows direct observation of vascular damage attributable to postprandial and postchallenge hyperglycemia. It also provides a means for direct assessment of the effect of medications used for the control of glucose excursions.