Mulberry twig alkaloids lower HbA1c with fewer gastrointestinal effects vs. acarbose
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Chinese adults with type 2 diabetes achieved a 0.93% HbA1c reduction with 24 weeks of mulberry twig alkaloid therapy, an outcome comparable with use of the alpha-glucosidase inhibitor acarbose, according to data published in Diabetes Care.
In a randomized, double-blind trial with 600 Chinese adults with type 2 diabetes, researchers also found that participants assigned mulberry twig alkaloid tablets experienced fewer gastrointestinal adverse effects compared with acarbose therapy.
“People in East Asia usually rely on starchy foods as their main source of calories; therefore, alpha-glucosidase inhibitors are often used as the first-line drug for the treatment of patients with diabetes in this region,” Ling Qu, of the department of traditional Chinese medicine at Peking Union Medical College Hospital in Beijing, and colleagues wrote in the study background. “However, these drugs are associated with a high incidence of gastrointestinal disorders, such as abdominal distension, abdominal pain and diarrhea, because of low selectivity to alpha-glucosidase. In vitro experiments have shown that mulberry twig alkaloids impart a significant inhibitory effect on sucrase and maltase, which is equal to or slightly stronger than that of acarbose. However, the inhibitory effect of mulberry twig alkaloids on amylase is much weaker than acarbose. This suggests that mulberry twig alkaloids have stronger disaccharidase selectivity and may help in reducing gastrointestinal disorders, such as flatulence.”
Qu and colleagues analyzed data from 600 adults who met 1999 WHO diagnostic criteria for type 2 diabetes and had not been treated for diabetes for more than 3 months. Participants were randomly assigned mulberry twig alkaloids (n = 360; 48.6% men; mean age, 55 years) or acarbose (n = 240; 53.2% men; mean age, 54 years) for 24 weeks. Primary endpoint was change in HbA1c compared with baseline. Researchers also assessed adverse events and gastrointestinal disorders.
At 24 weeks, change in HbA1c was –0.93% (95% CI, –1.03 to –0.83) and –0.87% (95% CI, –0.99 to –0.76) in the mulberry twig alkaloids and acarbose groups, respectively. The least squares mean difference was –0.05% (95% CI, –0.18 to 0.07) between the two groups, with no significant difference on the basis of covariance analysis.
Treatment-emergent adverse events and gastrointestinal disorders were lower in the mulberry twig alkaloids group vs. the acarbose group (P > .01); however, there were no between-group differences in adverse events or severe adverse events.
“In this study, mulberry twig alkaloid tablets and acarbose showed similar effects in reducing HbA1c,” the researchers wrote. “The effect of mulberry twig alkaloid tablets on body weight was equal to that of acarbose without hypoglycemia. In addition, mulberry twig alkaloid tablets caused fewer treatment-emergent adverse events and gastrointestinal disorders than acarbose, suggesting good tolerance in patients with type 2 diabetes.”
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