- Alpha-glucosidase inhibitors work by preventing the digestion of carbohydrates like starch and sugar. They do this by competitively inhibiting the enzymes needed to break down carbs into simpler sugars that can then be absorbed.
- This delays the absorption of carbohydrates and lowers post-meal blood glucose levels over the long-term. Current guidelines support their use alone or along with other drugs for poorly controlled type 2 diabetes.
- Common side effects include gas and stomach discomfort due to undigested carbs passing into the colon. Efficacy is modest but they provide glycemic control without weight gain or hypoglycemia risks seen with other drugs.
4. Alpha-glucosidase Inhibitors
α-Glucosidase inhibitors (AGI) are anti-
hyperglycemic agents that, by blockade of
oligosaccharide catabolism,
1. Delay (in small doses) or
2. inhibit (in larger doses) carbohydrate digestion and
absorption,
and, thus inhibit/ maintain smooth and lower blood
glucose levels after a meal.
Current consensus supports their use as
monotherapy or adjunct therapy for poorly
controlled NIDDM.
6. Alpha-glucosidase Inhibitors
Work by preventing the digestion of carbohydrates
Starch, table sugar
Carbohydrates normally digest to create simple
saccharides
Absorbed in the intestines (small)
Mechanism of action includes competitive inhibition
of enzymes needed to digest carbohydrates
Reduces rate of digestion of carbohydrates!
Long-term effects include a small decrease in
hemoglobinA1c levels
7. 7
Alpha-glucosidase Inhibitors
Efficacy
the enzyme α-glucosidase in the gut
Inhibit
Prevent conversion of complex CHO to simple CHO
Thus, delay the absorption of CHO
Hence, reduced PPBG excursions
Very modest in efficacy, usually take 6-8 weeks
Side Effects
Flatulence or abdominal discomfort common
No effect on lipids or blood pressure
No weight gain or loss
Contraindicated in IBD or Cirrhosis
8. Alpha-glucosidase Inhibitors
Acarbose Miglitol & Voglibose
postprandial hyperglycemia postprandial hyperglycemia
Inhibits glycoside hydrolases Inhibit glycoside hydrolases
glucosidase Taken at beginning of a meal
Taken at beginning of a meal Miglitol is systemically
Gastrointestinal side effects absorbed
Common Excreted by the kidneys
Higher efficacy than Voglibose Voglibose is newest:
less side effects
economical
Miglitol Voglibose
Acarbose
11. Alpha-glucosidase Inhibitors
Indications
Newly diagnosed patients insufficiently treated
with diet and dominating postprandial
hyperglycemia
Elderly multimorbid patients
Elderly patients with weight gain or hypoglycemia
under treatment with insulin secretagogues
Patients with hepatic or renal disorders
12. Advice to patients on AGIs
Start low, go slow
Prefer nutrients with complex carbohydrates (rice,
pasta, full
bread, vegetables, fruits)
Avoid refined carbohydrates (sugar, sweets).
Take only three meals
Avoid laxatives, such as sugar alcohols (sorbitol)
Control your postprandial blood glucose to
experience the efficacy of treatment
In most cases gastrointestinal side-effects are
transient
13. Alpha-glucosidase Inhibitors
AGIs have clear beneficial effects on
glycemic control and postload insulin levels
but not on plasma lipids.
In patients with type 2 diabetes, alpha
glucosidase inhibitors improve glycaemic
control in studies of mainly 24 weeks’
duration.
Data are lacking on the effects of alpha
glucosidase inhibitors on mortality, diabetes
related morbidity, and quality of life.