Alpha-glucosidase inhibitors are reversible inhibitors of alpha-glucosidase, an enzyme in the small intestine. They function by delaying the absorption of complex carbohydrates by the intestine, thereby inhibiting glucose peaks and subsequent insulin levels. Of the four alpha-glucosidase inhibitors (acarbose (Precose), migitol (Glyset), voglibose, and emiglitate) acarbose is the most prescribed of the drugs. Alpha-glucosidase inhibitors are often given to newly diagnosed diabetes patients and those who have blood sugar levels that are only slightly high enough to be considered diabetes. They are frequently prescribed in conjunction with other drugs for type 2 diabetes such as metformin. Because alpha-glycosidase inhibitors do not work with insulin function, they do not pose a risk of hypoglycemia. It should be noted however that when paired with other diabetes drugs there is a risk of hypoglycemia. If this occurs glucose gel should be consumed as orange juice and sugar will not work. Alpha-glycosidase inhibitors have been shown to be particularly useful to individuals who have trouble with raised blood glucose after a meal (postprandial hyperglycemia).
Alpha-glucosidase Inhibitors – Studies
A study from 1995 found that acarbose, used as a monotherapy, reported a decrease in A1C levels of 0.6% in comparison to a placebo. In a heavily debated study from 2003 on the efficacy of acarbose in patients with impaired glucose tolerance (IGT) was investigated, finding that it was able to prevent or delay the development of IGT into type 2 diabetes. It was also shown to reduce the risk of cardiovascular disease and hypertension.
In addition to their use as a diabetes treatment, scientist are also studying alpha-glucosidase inhibitors as a potential treatment for heart disease. The leading cause of death amongst diabetics, the benefits of this use would be tremendous. Impaired glucose tolerance (pre diabetes) and postprandial hyperglycemia have been linked to coronary artery disease. A Japanese study from 2009 investigated this link in diabetics with coronary heart disease (CAD) finding that miglitol improved postprandial glucose and lipid metabolism, incretin secretion, and endothelial dysfunction, suggesting that it may be useful as an anti-atherogenic agent. A separate study by a Japanese team in 2006 found that acarbose improved postprandial hyperglycemia and insulin levels and lowered cholesterol, triglycerides, and free fatty acids.
Who Should Not Take Alpha-glucosidase Inhibitors
The most common side effects are stomachache, gas, and diarrhea. Because of the digestive related side effects, people with liver disease, intestinal disease, or intestinal obstructions should not take alpha-glucosidase inhibitors. The side effects can be alleviated with a low sugar and carbohydrate diet, which is also beneficial for all diabetics. The FDA has not approved alpha-glucosidase inhibitors as a treatment for children or pregnant or nursing women.
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