Effects of alpha-glucosidase-inhibiting drugs on acute postprandial glucose and insulin responses: a systematic review and meta-analysis

Abstract

Background/objectives Despite considerable literature supporting the potential health benefits of reducing postprandial glucose (PPG), and insulin (PPI) exposures, the size of a clinically relevant reduction is currently unknown. We performed a systematic review and meta-analysis to quantify effects of alpha-glucosidase-inhibiting (AGI) drugs on acute PPG and PPI responses. Methods We searched EMBASE and MEDLINE until March 13, 2018 for controlled studies using AGI drugs together with a standardized carbohydrate load or mixed meal. The mean incremental PPG and PPI levels were calculated as outcomes. Meta-analyses, stratified by diabetes state, were performed by using random effects models. Results The 66 included publications comprised 127 drug-control comparisons for PPG, and 106 for PPI, mostly testing acarbose or miglitol. The absolute effects on PPG were larger among individuals with diabetes (−1.5 mmol/l mean PPG [95% CI −1.9, −1.1] by acarbose, and −1.6 [−1.9, −1.4] by miglitol) as compared to individuals without diabetes (−0.4 [95% CI −0.5, −0.3] by acarbose, and −0.6 [−0.8, −0.4] by miglitol). Relative reductions in PPG by both drugs were similar for diabetic and non-diabetic individuals (43−54%). Acarbose and miglitol also significantly reduced mean PPI, with absolute and relative reductions being largest among individuals without diabetes. Conclusions The present meta-analyses provide quantitative estimates of reductions of PPG and PPI responses by AGI drugs in diabetes and non-diabetic individuals. These data can serve as benchmarks for clinically relevant reductions in PPG and PPI via drug or diet and lifestyle interventions.

Acarbose is again on the stage

“…Acarbose inhibits carbohydrate digestion by competitively inhibiting the alpha glucosidase enzyme in the small intestine lumen. Consequently, it reduces glucose absorption, prevents postprandial hyperglycemia and hyperinsulinemia, and increases insulin sensitivity[ 12 ]. For this reason, it has been used in clinical practice since the 1990s, whether in monotherapy for mild cases of type 2 diabetes or as a combination agent with insulin and other antidiabetics in severe and advanced cases.…”

“…In order to reduce gastrointestinal intolerance, a daily dose of 50 mg is offered just before meals, and a dose of 100 mg is offered three times a day after four to six weeks, when weekly titrations are reached. Acarbose can decrease hemoglobin A1c (HBA1c) by 0.5% to 1.5% and is especially effective on postprandial hyperglycemia[ 12 ].…”

Synthesis of (+)-(R)-Tiruchanduramine

“…They are targets for treatments to viral infections, diabetes, lysosomal storage disorders, and cancer [4]. Glucosidases involved in digestion have attracted particular interest as they release glucose and inhibiting them slows rises in blood sugar following food consumption and medications such as Acarbose [5] and Miglitol [6] have been developed.…”

“…They are targets for treatments to viral infections, diabetes, lysosomal storage disorders, and cancer [4]. Glucosidases involved in digestion have attracted particular interest as they release glucose and inhibiting them slows rises in blood sugar following food consumption and medications such as Acarbose [5] and Miglitol [6] have been developed. We wished to determine the absolute configuration of 1 by synthesis from a chiral pool precursor and were initially attracted by the synthesis reported by Ravinder et al [2].…”

One-pot multi-component synthesis of novel chromeno[4,3-b]pyrrol-3-yl derivatives as alpha-glucosidase inhibitors

“…Diabetes is also a risk factor for cardiovascular disease, cognitive decline, and Alzheimer's dementia [ 8 ]. The concerning trends in incidence, prevalence, and mortality of T2DM as well as its economical burden promote researchers to develop new agents to reduce exposure to high glucose levels in the postprandial state [ 9 ].…”