Acarbose diabetic patients

Hanefeld M et al Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients Meta-analysis of seven long term studies. Eur Heart 3 2004 25 10. [PMID 14683737]... 

Spengler M, Schmitz H, Landen H. Evaluation of the efficacy and tolerability of acarbose in patients with diabetes mellitus. A post marketing surveillance study Clin Drug Invest 2005 25 651-9. 

Vichayanrat A, Ploybutr S, Tunlakit M, Watanakejorn P. Efficacy and safety of voglibose in comparison with acarbose in type 2 diabetic patients. Diabetes Res Clin Pract 2002 55(2) 99-103. 

Hasche H, Mertes G, Bruns C, Englert R, Genthner P, Heim D, Heyen P, Mahla G, Schmidt C, Schulze-Schleppinghof B, Steger-Johannsen G. Effects of acarbose treatment in type 2 diabetic patients under dietary training a multicentre, double-blind, placebo-controlled, 2-year study. Diabetes Nutr Metab 1999 12(4) 277-85. 

Phillips P, Karrasch J, Scott R, Wilson D, Moses R. Acarbose improves glycemic control in overweight type 2 diabetic patients insufficiently treated with metformin. Diabetes Care 2003 26(2) 269-73. 

Yoo WH, Park TS, Baek HS. Marked weight loss in a type 2 diabetic patient treated with acarbose. Diabetes Care 1999 22(4) 645-6. 

Azami Y. Paralytic ileus accompanied by pneumatosis cystoides intestinalis after acarbose treatment in an elderly diabetic patient with a history of heavy intake of maltitol. Intern Med 2000 39(10) 826-9. 

Oba K, Kudo R, Yano M, Watanabe K, Ajiro Y, Okazaki K, Suzuki T, Nakano H, Metori S. Ileus after administration of cold remedy in an elderly diabetic patient treated with acarbose. J Nippon Med Sch 2001 68(l) 61-4. 

Nagai Y, Hayakawa T, Abe T, Nomura G. Are there different effects of acarbose and voglibose on serum levels of digoxin in a diabetic patient with congestive heart failure Diabetes Care 2000 23(11) 1703. 

Acarbose is used in diabetes in addition to other therapeutic regimes in connection with diet. Its clinical usefulness was demonstrated (Hanefeld et al., 1991) but its extent is a matter of controversy. However, a diet is preferable in Type-II diabetes. There are some studies which show the usefulness of its combination with sulphonylureas. Considerable individual variation is noted in the response to acarbose (Reaven et al., 1990). The use of acarbose in patients with NIDDM not well controlled by sulphonylureas appears to have significant clinical benefit (Raptis et al., 1982). One study suggests that it is not an effective substitute for sulphonylureas in non-obese Type-II diabetes uncontrolled by diet alone (Buchanan et al., 1988). 

In healthy humans, acarbose reduces postprandial hyperglycaemia, hyper-insulinaemia and hypertriglyceridaemia and may therefore be a useful tool for the treatment of diabetic patients and the metabolic syndrome. 

In conclusion, the best indication for acarbose is in the early stages of NIDDM and in overweight diabetic patients who do not respond well to diet therapy. Acarbose can be used as monotherapy and also in association with sulphonylureas and insulin. It lowers postprandial and fasting blood glucose, decreases hypertriglyceridaemia and hyperinsulinaemia, and improves HbAj. It is therefore justified to expect also a beneficial effect of acarbose on the development of long-term diabetic complications. 

Low-grade inflammation is closely associated with the metabolic syndrome and is an accepted new cardiovascular risk factor. Reductions in postprandial glucose excursion by treatment with acarbose in patients with type 2 diabetes have shown to reduce the activity (p = 0.045) and nuclear localization (p = 0.02) of the proinflammatory transcription factor NFkB, suggesting a mechanism by which the anti-inflammatory effects of acarbose may be mediated [8]. This mechanism would be consistent with reductions in the level of coagulation factors seen with acarbose treatment. For example, acarbose has been shown to reduce the level of fibrinogen in patients with type 2 diabetes (p = 0.013 vs. placebo) [42] and serum C-reactive protein levels in individuals with IGT (p < 0.01 vs. placebo) [43]. We found a significant reduction in postprandial leukocyte excursion another indicator... 

May C. Efficacy and tolerabihty of step wise increasing dosage of acarbose in patients with non-insuhn-dependent diabetes (NIDDM) treated with suUbnylureas. Diabetes Stoffwechsel 1995 4 3-7. 

Another study in 19 diabetic patients given acarbose 50 or 100 mg three times daily and metformin 500 mg twice daily, also found that acarbose lowered metformin levels (AUC reduced by 12 to 13%, maximum plasma levels reduced by 17 to 20%). Nevertheless, the drug combination reduced the postprandial glucose concentration at 3 hours by 15% mote than metformin alone. Similarly, the manufacturer notes that, in a study in healthy subjects, miglitol 100 mg three times daily for 7 days reduced the AUC and maximum level of a single 1-g dose of metformin by 12% and 13%, respectively, although this difference was not statistically significant. ... 

Some but not all studies have found that digoxin plasma levels can be markedly reduced by acarbose. Miglitol modestly reduced digoxin levels in healthy subjects, but no change was seen in diabetic patients. Voglibose does not appear to interact adversely with digoxin. 

A reduction in blood glucose increases and a decrease in peak to trough fluctuations in blood glucose were observed in type 2 diabetes patients (without complications and with use of oral hypoglycemic agents) orally administered single doses of 1 g white mulberry leaf extract. Patients were allowed to continue taking any medication except acarbose (Mudra et al. 2007). 

Gastrointestinal In a prospective, randomised, open-label study with diabetic patients (n = 60) treated with human insulin plus acarbose, the most frequent adverse effect was abdominal distension (n = 22,36%). These adverse effects were acarbose-dose-related from acarbose 50 mg once daily to 50 mg three times daily. [18 ]... 

The a-glucosidase inhibitors are contraindicated in patients with a hypersensitivity to the drug, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to intestinal obstruction, or chronic intestinal diseases. Acarbose and miglitol are used cautiously in patients with renal impairment or pre-existing gastrointestinal (GI) problems such as irritable... 

In a post-marketing surveillance study in 27 803 patients with diabetes mellitus (94% type 2), data were reported after 12 weeks. The doses of acarbose were low 4.1% took less than 100 mg/day, 64% 100-250 mg/day, 32% 250-300 mg/day, and 0.1% more than 300 mg/day. Only 2.1% stopped therapy, mainly because of gastrointestinal adverse events. Tolerability appeared to be good and independent of age. Abnormal liver function was reported in 0.01%. The difference between these results and those of many controlled trials may in part be explained by the fact that higher doses have been used in most trials (14). 

In a comparison of voglibose and acarbose in 21 in-patients with type 2 diabetes who took part in a randomized crossover study of acarbose 150 mg/day and voglibose 0.9 mg/day, there was marked interindividual variation in response (18). For both drugs efficacy was better in those with gastrointestinal adverse effects, such as abdominal distention and flatulence. 

The effect of adding acarbose (maximum 100 mg tds) or placebo to insulin (20) or metformin (21) has been investigated in 1946 patients with type 2 diabetes. The results were comparable with the results of the UK Prospective Diabetes Study (22). After 3 years, 39% were still using acarbose compared with 58% using placebo. The main reasons for stopping were flatulence (30 versus 12%) or diarrhea (16 versus 8%). After 3 years the HbAic concentration was 0.5% lower (median 8.1 versus 8.6%). Acarbose was equally effective when added to diet, sulfonylurea, metformin, or insulin. 

When acarbose or placebo was given to patients with type 1 diabetes taking insulin, acarbose reduced postprandial blood glucose but there was no difference in HbAic the only adverse effects were gastrointestinal (23). 

Long-term acarbose had a good effect on late dumping syndrome in six patients with type 2 diabetes one patient complained of increased flatulence (41). 

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