Voglibose for prevention of type 2 diabetes mellitus

Abstract

Lifestyle interventions are effective for the prevention of type 2 diabetes in different populations with impaired glucose tolerance in the USA, 1 north Europe, 2 China, 3 and Japan. 4 Not only were the results impressive at the end of the intensive intervention trials, but long-term follow-up studies also confirmed the effect of lifestyle interventions for the prevention of diabetes in individuals at high risk of developing the disease. 2,3 Various drugs are efficacious in the prevention of type 2 diabetes in individuals with impaired glucose tolerance (figure). Glucose-lowering drugs preventedthe development of type 2 diabetes in placebo-controlled clinical trials. 1,3 Metformin reduced the relative risk of new-onset diabetes at the end of the US Diabetes Prevention Programme by 31%, 1 and a 26% reduction was seen inthe Indian Diabetes Prevention Programme. 8 Treatment with thiazolidinediones resulted in a greater risk reduction (60% with rosiglitazone in DREAM, 11 and 81% with pioglitazone in ACT-NOW 12-14 ). However, because both metformin and glitazones positively affect the pathophysiology of type 2 diabetes, 15 and because the main reported results were analysed without any washout period, the distinction between a masking and atrue preventive effect is almost impossible. 16 Another approach that would not directly affect insulin sensitivity or insulin secretion is to competitively inhibit intestinal α-glucosidase enzymes. 17 In the STOP-NIDDM trial, 6 done in Canada and various European countries, a 25% reduction was reported in the number of patients with new-onset diabetes and impaired glucose tolerance who were given acarbose (100 mg three times a day) compared with those given placebo after a 3-year followup. 6 Furthermore, acarbose significantly increased reversion of impaired glucose tolerance to normal. However, at the end of the study, treatment with placebo for 3 months was associated with an increase in conversion of impaired glucose tolerance to diabetes. Because acarbose does not interfere with the intestinal absorption of the monosaccharide glucose that is ingested during the oral glucose tolerance test, a masking effect seems unlikely compared with previous discussions about metformin or glitazones. 16 α-glucosidase inhibitors seem to exert a good glucose-lowering effect (with an acceptable gastrointestinal tolerance) in Asian people, presumably because of specific food habits. 18 Therefore the results of the trial by Kawamori and colleagues in The Lancet today, in which the effect of voglibose (another α-glucosidase inhibitor) was assessed in Japanese patients with impaired glucose tolerance, raise much interest. 5 Analysis after almost 50 weeks of treatment showed that voglibose (0 . 2 mg three times a day) reduced the risk of patients with impaired glucose tolerance developing type 2 diabetes by 40 . 5% and increased the proportion who achieved normoglycaemia by 53 . 9% compared with those given placebo. The underlying mechanism of action is not known. Unlike metformin and glitazones...

Treating Hyperglycemia From Eryngium caeruleum M. Bieb: In-vitro α-Glucosidase, Antioxidant, in-vivo Antidiabetic and Molecular Docking-Based Approaches

“…Alpha-glucosidase inhibitors represent a group of antidiabetic drugs that regulate postprandial hyperglycemia through inhibition of carbohydrates digestion in the small intestine and thus hamper the diet associated with acute glucose excursion (Dwek et al, 2002). Among these drugs, acarbose and voglibose have got substantial attention in the past decades due to their effectiveness in controlling type 2 DM (Scheen, 2009). Acarbose is a natural product obtained from the fermentation of Actinoplanes species (Truscheit et al, 1981).…”

Inhibitory potential on key enzymes relevant to type II diabetes mellitus and antioxidant properties of the various extracts and phytochemical constituents from Rumex acetosella L

“…Plant phytoconstituents may also be involved in the emergence of plant‐associated activities. In the last past decades, acarbose and voglibose with natural origins have been approved for the treatment of type II DM (Bedekar, Shah, & Koffas, 2010; Dabhi, Bhatt, & Shah, 2013; Scheen, 2009; Toeller, 1994; Tundis, Loizzo, & Menichini, 2010). Acarbose acts on both α ‐amylase and α ‐glucosidase, whereas voglibose selectively inhibits α ‐glucosidase.…”

Inhibitory Activities of Caffeoylquinic Acid Derivatives from Ilex kudingcha C.J. Tseng on α-Glucosidase from Saccharomyces cerevisiae

“…α-Glucosidase, located at the brush-border surface membrane of intestinal cells, is the key enzyme catalyzing the final step in the digestive process of carbohydrates that liberate glucose. Hence, α-glucosidase inhibitors can delay carbohydrate digestion and reduce the rate of glucose absorption, resulting in reduced postprandial plasma glucose levels and suppressed diabetes. , For example, acarbose and voglibose, two of the clinically approved drugs for the treatment of type 2 diabetes, have been demonstrated to act by this mechanism. , However, the use of these drugs may be associated with some undesirable side effects, the most commonly observed being weight gain, hyperglycemia, and gastrointestinal disturbances. , Thus, recently more attention has been paid to other effective and safe α-glucosidase inhibitors from natural ingredients or herbal extracts, which have been used medicinally for many years for the prevention of metabolic disorders such as diabetes and obesity. − …”