Considerations when using alpha-glucosidase inhibitors in the treatment of type 2 diabetes

ABSTRACT

Introduction: Alpha-glucosidase inhibitors (AGIs) – oral antihyperglycemic drugs, inhibit upper gastrointestinal enzymes that break down complex carbohydrates into glucose. As a result, the absorption of glucose is delayed, postprandial glucose reduced, and glycemic control improved.

Areas covered: In this review, the authors describe the current recommendations on the use of the three major approved AGIs (acarbose, miglitol, voglibose). Efficacy and safety parameters together with ethnic considerations have been highlighted throughout the manuscript. The article also discusses potential diabetes prevention and cardiovascular effects of these medications.

Expert opinion: The overall safety and efficacy of this class of drug appears to be high: AGIs do not increase the risk of hypoglycemia, do not cause weight gain; they also significantly improve postprandial hyperglycemia, have been associated with the reduction in risk factors for cardiovascular disease and may also delay the progression of prediabetes to T2DM. In general, we continue to believe that acarbose, miglitol, and voglibose should be used as third-line add on treatment options to other anti-hyperglycemic agents. However, this class can have earlier consideration in elderly and/or when metformin is contraindicated.

KEYWORDS:

• Glucose
• type 2 diabetes
• acarbose
• alpha glucosidase inhibitors

Article highlights

• Alpha-glucosidase inhibitors (AGIs) are oral antihyperglycemic drugs that act by competitive and reversible inhibition of intestinal alpha-glucosidases.

• When used as monotherapy, average reduction in hemoglobin A1c (HbA1c) is 0.8%.

• Reductions in postprandial glucose have been reported to be greater with AGIs as compared with placebo or other anti-hyperglycemic agents.

• Acarbose has been associated with the reduction in cardiovascular disease risk and potential reduction in progression of prediabetes.

• The most limiting factor for the AGI use is gastrointestinal side effects: flatulence, diarrhea, abdominal pain.

• The AGIs are well tolerated in elderly T2DM individuals.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.