Effect of additional administration of acarbose on blood glucose fluctuations and postprandial hyperglycemia in patients with type 2 diabetes mellitus under treatment with alogliptin

Abstract

Abstract. Acarbose was administered at 300 mg/day to patients with type 2 diabetes mellitus (T2DM) who had been taking 25 mg/day of alogliptin, and levels of blood glucose were analyzed by continuous glucose monitoring (CGM) for 3 days. The mean blood glucose level with acarbose (136.4 ± 30.7 mg/dL) did not differ significantly from that without acarbose (141.7 ± 28.3 mg/dL). However, in the condition of the combination therapy, there were significant decreases in the standard deviation of the mean blood glucose levels for the 24-hour period (27.6 ± 9.1 vs. 16.2 ± 6.9 mg/dL, p<0.001) and mean amplitude of glycemic excursions (MAGE) (65.8 ± 26.1 vs. 38.8 ± 19.2 mg/dL, p=0.010). In addition, a meal tolerance test was conducted to monitor changes in insulin secretion and active GLP-1 and total GIP values. Ten subjects (5 males, 5 females) of 54.9 ± 6.9 years with BMI 25.9 ± 5.2 kg/m 2 and HbAlc 9.2 ± 1.2% were enrolled. In the meal tolerance test, active GLP-1 values before and after acarbose administration were 17.0 ± 5.8 and 24.1 ± 9.3 pmol･hr/mL (p=0.054), respectively, showing an increasing tendency, and total GIP AUC0-180 values were 685.9 ± 209.7 and 404.4 ± 173.7 pmol･hr/mL, respectively, showing a significant decrease (p=0.010). The results indicate that the combined administration of both inhibitors is effective not only in decreasing blood glucose fluctuations and preventing postprandial insulin secretion. The beneficial effects may also protect the endocrine pancreas and inhibit body weight gain.

Saxagliptin is similar in glycaemic variability more effective in metabolic control than acarbose in aged type 2 diabetes inadequately controlled with metformin

“…As a result, GV is regarded as an important risk factor in the development of diabetic complications. Our results confirmed previously published papers reporting that acarbose reduced GV [3][4]11]. Saxagliptin is a dipeptidylpeptidase-4 (DPP-4) inhibitor, which increase glucose-dependent insulin secretion and suppress glucagons secretion [12].…”

“…It should be considered along with HbA1c in the management of diabetes [2]. As an add-on drug, acarbose is known to improve GV [3][4].Saxagliptin is a new anti-diabetic drug, whose effect on GV is still unclear. Therefore we compared the glucose control and GV between saxagliptin and acarbose as add-on therapies for aged type 2 diabetes mellitus (T2DM) inadequately controlled with metformin alone.…”

Clinical pharmacology of dipeptidyl peptidase 4 inhibitors indicated for the treatment of type 2 diabetes mellitus

“…For detailed clinical pharmacology of alogliptin, please read recent reviews about this drug. 38,[41][42][43][44][45][46][47][48][49] Alogliptin as monotherapy or added to metformin, [50][51][52] pioglitazone, [53][54][55][56] glipizide, 57,58 glyburide/glibenclamide, 59 voglibose, [60][61][62] miglitol, 62 acarbose, 63 or insulin 64,65 significantly improves glycaemic control compared with placebo or active comparators in adult or elderly patients with inadequately controlled T2DM. This is associated with good gastrointestinal tolerability and a low incidence of hypoglycaemia.…”

Efficacy of adding once- and thrice-daily voglibose in Japanese type 2 diabetic patients treated with alogliptin

“…Second, the combined use of alogliptin might favorably modulate the glucose-lowering effect of voglibose, via enhancing its effect on incretin, especially glucagon-like peptide 1 (GLP-1) [30,31,43,44]. Alpha-glucosidase inhibitors prolong and enhance the secretion of GLP-1 from the intestine [45][46][47][48][49][50], whereas DPP-4 inhibitors suppress the inactivation of the secreted incretin.…”

“…Recently, a favorable effect of alpha-glucosidase inhibitors as an add-on to DPP-4 inhibitors has been suggested by some clinical studies [30][31][32]. In addition, it is also suggested that although the agents are usually administered thrice a day, only a once-daily administration might have some efficacy on glycemic control [33].…”