Thus, there is a need to examine the associations between glucose fluctuations and the concentrations of circulating CVD risk factors in subjects with type 2 diabetes or IGT and healthy subjects in cross-sectional studies. Additionally, whether subjects with Stattic concentration higher circulating concentrations of CVD risk factors accompanied by glucose fluctuations had higher subsequent incidence of CVD should be explored in cohort studies. In addition, randomized, double-blind, placebo-controlled (RCT) trials are needed

to examine whether repression of circulating CVD risk factor concentrations by miglitol, but less so by other α-GIs, reduces the subsequent incidence of CVD in type 2 Vactosertib diabetic patients. tPAI-1 and FABP4 are expressed from adipose tissues and related to lipid metabolism. Thus, switching α-GIs from acarbose or voglibose to miglitol may not reduce lipid abnormalities related to atherogenesis risk. It has been reported from an RCT conducted in Germany that drugs improving lipid metabolism (insulin resistance) such as metformin and pioglitazone and their combination reduced tPAI-1 concentrations in type 2 diabetic patients receiving stable basal insulin therapy [26],

although it is still unclear whether circulating FABP4 concentrations are reduced by these drugs. The combination of miglitol with these drugs for improving insulin resistance may reduce CVD development by decreasing circulating concentrations of tPAI-1, MCP-1, and sE-selectin. This hypothesis should be examined MDV3100 concentration in interventional trials. Switching from acarbose or voglibose to miglitol for 3 months has been found to reduce hypoglycemic symptoms and blood glucose concentrations

between meals [19]. It has been shown that hypoglycemia is strongly and positively associated with subsequent CVD incidence Idelalisib molecular weight [27]. Thus, reducing hypoglycemia using miglitol may reduce CVD risk; however, hypoglycemic symptoms in our trials were self-reported. The self-reported hypoglycemic symptoms were limited because they may be underreported by patients to medical staff. A previous study has demonstrated that postprandial hyperglycemia within 1 h after a standard meal loading was higher, and that over 1 h was lower, in viscerally obese Japanese subjects treated with miglitol compared with those treated with acarbose [17]. In addition, it was reported that treatment with miglitol, but not with acarbose or voglibose, in Japanese women who had undergone a total gastrectomy reduced reactive hypoglycemia [28]. Combining our results with those of previous studies, treatment with miglitol could be a lower risk of hypoglycemia rather than other α-GIs. Further large-scale studies should examine whether miglitol treatment of type 2 diabetic patients reduces hypoglycemia assessed by SMBG and hypoglycemic symptoms, such as hypoglycemia-induced lethargy, compared with other α-GIs.