Alpha Glucosidase

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Alpha-glucosidase inhibitors are diabetes medication, which slows down carbohydrate digestion and limits blood-glucose rise after food, a common problem in diabetics.

Take this medication with your main meals; it decreases postprandial glucose without causing hypoglycemia. Alpha-glucosidase inhibitors are suitable as mono-therapy or in combination with sulfonylureas for management of type 2 diabetes.  It can have synergistic effects when in use with other diabetic drugs and may combine well with insulin.

In patients with abnormal renal function, acarbose can safely use. If diabetes is still not well controlled, insulin is required.

Alpha-glucosidase inhibitor’s mechanism of action

Alpha-Glucosidase inhibitors work by inhibiting alpha-glucosidase, an enzyme located in the proximal gut (small-intestinal) epithelium that breaks down disaccharides and carbohydrates that are more complex. Through this enzyme inhibition, this drug delays intestinal carbohydrate absorption, thus attenuating postprandial glucose excursions.

Alpha-glucosidase inhibitor’s diabetes medications

  • Generic name: Acarbose (Brand name: Glucobay, Prandase in Canada, Philippines, United Kingdom, India, Australia and other countries; Acarbose Emcure, Acarbose Strides Arcolab, Acarbose Watson, Acarbose, Precose in United States; Acarex, Asucrose, Diabose, Glucar, Glucobay, Gludase, K-Carb, Rebose in India)
  • Generic name: Miglitol (Brand name: Glyset; Diamig, Elitox, Euglitol, Miglit, Mignar, Migtor, Misobit in India; Glycet in United States)

Alpha-glucosidase inhibitor’s dosage

Initial dose is 50 mg/day and titrate accordingly, usual dose 50 to 100 mg during main meals and maximum dose 100 mg three times a day.

Side effects of alpha-glucosidase

Side effects of alpha-glucosidase inhibitors include flatulence (77%), diarrhea (33%), and abdominal discomfort (21%). Slow titration may attenuate these gastrointestinal adverse effects over time.  

What you can expect for Alpha-glucosidase inhibitors?

As a mono-therapy, alpha-glucosidase inhibitors can decrease your fasting plasma glucose (FPG) by 20 to 30 mg/dl or 1.11 to 1.67 mmol/l and hemoglobin A1C by 0.7 to 1%. Additionally, it decreases your post-prandial glucose by 30 to 70 mg/dl or 1.67 to 3.89 mmol/l. It has a minimal effect on cholesterol and body weight.

Who can benefit from Alpha-glucosidase inhibitors?

Alpha-glucosidase inhibitors are particularly useful in postprandial hyperglycemia. It effectively reduces your blood glucose spikes immediately after meals.

Who should avoid using Alpha-glucosidase inhibitors?

Alpha-glucosidase inhibitors are contraindicating in patients with inflammatory bowel disease, partial intestinal obstruction, a predisposition to intestinal obstruction, colonic ulceration and other gastrointestinal disorders.

Acarbose may elevate liver function; therefore, monitor hepatic enzymes every 3 months for 1 year, thereafter periodically. However, miglitol excrete primarily by the kidneys, thus use with caution in moderate to severe renal failure.

This drug has a link with dose-dependent hepatotoxicity, so monitor liver function tests in patients who receive high dosages of this medication (more than 50 mg three times daily). Transaminase elevations are reversible with discontinuation of this drug and are often asymptomatic. Serum transaminase levels should check every three months for the first-year patients taking the medication and periodically thereafter. Drugs that are susceptible to binding with other agents (such as cholesterol medications “cholestyramine”) should take two to four hours apart from alpha-glucosidase inhibitors to avoid its interactions. Intestinal absorbents and digestive enzyme preparations should not take with this medication.

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