Alpha Glucosidase Inhibitors: Acarbose and Miglitol

Acarbose (Precose, Glucobay) and Miglitol (Glycet) are oral medications used to treat type 2 diabetes patients and belong to a class of drugs named Alpha Glucosidase Inhibitors.

Alpha Glucosidase inhibitors are usually prescribed to type 2 diabetes patients in combination with other diabetes medications, most commonly metformin, sulfonylureas, or DPP-4 inhibitors.   

How Do Alpha Glucosidase Inhibitors Work?

Alpha Glucosidase inhibitors act in the intestine to block the action of enzymes that are responsible for breaking down complex carbohydrates into simple sugars. The delayed breakdown of carbohydrates helps slow down their absorption into the bloodstream, and thus slow down the increase in blood glucose levels after a meal.

These medicines are not usually used for primary therapy unless a patient appears to have large increases in blood glucose after meals (“postprandial”).


Side effects of Alpha Glucosidase Inhibitors

Gastrointestinal side effects are common in patients using glucosidase inhibitors, affecting up to 30% of patients.  Bloating, flatulence, diarrhea and abdominal discomfort and pain are the major complaints. However, these side effects can be reduced by reducing carbohydrate intake.

Use of glucosidase inhibitors like Acarbose (Precose, Glucobay) and Miglitol (Glycet) does not cause weight gain.


Alpha Glucosidase Inhibitors and Prevention of Diabetes

Alpha-glucosidase inhibitor may also be effective in the prevention of type 2 diabetes in patients with impaired glucose tolerance.

In trials, use of Alpha-glucosidase inhibitor resulted in a 25% decrease in incidence of diabetes when compared to patients who did not receive the medication. Unfortunately about 20% of patients withdrew from the acarbose arm of the study because of gastrointestinal side effects accompanying the drug.  A similar study did not show this dramatic decrease, but did show a decrease in sugar levels after meals.

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Reviewed by Dr. Mariela Glandt, Apr. 2013 

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