Alpha glucosidase inhibitors

Alpha-glucosidase inhibitors are a new class of drugs used in the treatment of non-insulin-dependent diabetes mellitus (NIDDM).

• acts by reversible inhibition of the gastrointestinal sucrase, glucoamylase, dextrinase, maltase and isomaltase enzymes. These normally convert dietary starch and sucrose into absorbable monosaccharides. Enzyme inhibition therefore delays and reduces the peak of postprandial blood glucose
• an example of an alpha-glucosidase inhibitor is Acarbose
• a systematic review concerning alpha-glucosidase inhibitors concluded that (2):
  • it is unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes
  • these agents have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. However these effects are less sure when alpha-glucosidase inhibitors are used for a longer duration
  • acarbose dosages higher than 50 mg TDS offer no additional effect on glycated hemoglobin but more adverse effects instead
  • compared to sulphonylurea, alpha-glucosidase inhibitors lower fasting and post-load insulin levels and have an inferior profile regarding glycemic control and adverse effects

Reference:

1. Drug and Therapeutics Bulletin 1999; 37 (11): 84-87.
2. van de Laar FA et al. Alpha-glucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis. Diabetes Care 2005;28:154-63