Background:The guidelines from ADA and EASD indicate that whether AGIs can reduce the risk of cardiovascular events in patients with type-2 diabetes mellitus is unclear. The effect of alpha-glucosidase inhibitors on cardiovascular events in patients with type-2 diabetes is unclear.

Objectives:To assess whether the AGIs therapy was associated with increased risk of cardiovascular events in patients with type-2 diabetes.

Methods:We searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to May 2015. We included a study if it was a RCT, cohort study, or case-control study that compared AGIs against placebo, lifestyle modification, or active anti-diabetic medication in adult type-2 diabetes patients. We also required the eligible study having follow up for at least 12 weeks (not applicable to case-control studies), and having explicitly reported the outcome of any cardiovascular events (either reported as raw data or adjusted effect estimates with 95% confidence intervals). We classified study designs according to recommendations by the Cochrane Non-Randomised Studies Methods Group.

Results: We identified a total of 5318 potentially relevant reports. Ultimately, 18 studies proved eligible, including 16 RCTs and 2 cohort studies. Ten trials reported 129 any cardiovascular events occurred in 4465 patients who used at least one medication (raw event rate 2.9%). The pooling of those trials showed a statistically significant difference in the risk of any cardiovascular events between AGIs treatment and control (OR 0.66, 95% CI 0.44 to 0.98; I-square=26%).

Conclusions:In summary, the available evidence suggests the possibility that AGIs could reduce the risk of any cardiovascular events and MI, although their effects on CI, heart failure and cardiovascular mortality remain uncertain. The current body of evidence, however, is not definitive. More carefully designed, conducted, adequately powered trials are warranted.