Acarbose: safe and effective for lowering postprandial hyperglycaemia and improving cardiovascular outcomes

DiNicolantonio, James J.; Bhutani, Jaikrit; O’Keefe, James H.

doi:10.1136/openhrt-2015-000327

Cited by 176 publications

(132 citation statements)

References 169 publications

(164 reference statements)

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“…Their main adverse effect is flatulence and other gastrointestinal symptoms. 142,143 Meglitinides (repaglinide and nateglinide) are shortacting insulin secretagogues which act to restore the disrupted early-phase secretion of postprandial insulin. They are administered 15 minutes before a meal and their action begins within 30 minutes of meal inception.…”

Section: Pharmacological Treatment Targeting Postprandial Hyperglycemiamentioning

confidence: 99%

Postprandial dysmetabolism: Too early or too late?

Pappas¹,

Kandaraki²,

Tsirona³

et al. 2016

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postprandial dysmetabolism is a postprandial state characterized by abnormal metabolism of glucose and lipids and, more specifically, of elevated levels of glucose and triglyceride (Tg) containing lipoproteins. Since there is evidence that postprandial dysmetabolism is associated with increased cardiovascular mortality and morbidity, due to macro-and microvascular complications, as well as with conditions such as polycystic ovary syndrome (pCOS) and nonalcoholic fatty liver disease (NaFlD), it is recommended that clinicians be alert for early detection and management of this condition. management consists of a holistic approach including dietary modification, exercise and use of hypoglycemic and hypolipidemic medication aiming to decrease the postprandial values of circulating glucose and triglycerides. This review aims to explain glucose and lipid homeostasis and the impact of postprandial dysmetabolism on the cardiovascular system as well as to offer suggestions with regard to the therapeutic approach for this entity. however, more trials are required to prevent or reverse early and not too late the actual tissue damage due to postprandial dysmetabolism.

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Section: Pharmacological Treatment Targeting Postprandial Hyperglycemiamentioning

confidence: 99%

Postprandial dysmetabolism: Too early or too late?

Pappas¹,

Kandaraki²,

Tsirona³

et al. 2016

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“…1) However, acarbose and voglibose as part of α-glucosidase inhibitors (AGIs) are another class of anti-diabetic medications. As first-line hypoglycemic drugs used in patients with type 2 diabetes especially in Asian since their diet meals contain high content of carbohydrates, acarbose and voglibose can typically reduce postprandial glucose level by delaying carbohydrate digestion in the gut, so they can be a useful treatment in the patients who raised basal glucose concentrations slightly and marked postprandial hyperglycemia.…”

mentioning

confidence: 99%

Comparisons of Effects on Intestinal Short-Chain Fatty Acid Concentration after Exposure of Two Glycosidase Inhibitors in Mice

Cai

et al. 2018

Biological & Pharmaceutical Bulletin

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Acarbose and voglibose are the most widely used diabetes drugs as glycosidase inhibitors. In this study, the use of these two inhibitors significantly increased the content of starch in large intestine, and altered the concentration of short-chain fatty acids (SCFAs) by affecting the intestinal microbiota. However, there are some differences in the intestinal microbiome of the two groups of mice, mainly in bacteria such as Bacteroidaceae bacteroides and Desulfovibrionaceae desulfovibrio. The productions of acetate and propionate in caecum in voglibose group were significantly higher than those in acarbose group and two kinds of glycosidase inhibitors were close in the production of butyrate in caecum. The Tax4Fun analysis based on Kyoto Encyclopedia of Genes and Genomes (KEGG) data indicated that different productions of acetate and propionate between acarbose group and voglibose group may be related to 2-oxoisovalerate dehydrogenase and pyruvate oxidase. In addition, in-vitro experiments suggested that voglibose had less effect on epithelial cells than acarbose after direct stimulation. According to the recent researches of SCFAs produced by intestinal microbiota, our comparative study shown higher concentration of these beneficial fatty acids in the lumen of voglibose-treated mice, which implied a lower level of inflammation.Key words acarbose; voglibose; microbiota; short-chain fatty acid; Tax4FunWith the increasing number of obesity and diabetes around the world, there are more and more different classes of medications to treat diabetes, such as biguanides (metformin), sulfonylureas, insulin, glucagon-like peptide 1 (GLP-1) agonists, dipeptidyl peptidase IV inhibitors, thiazolidinediones and sodium-glucose transporter 2 inhibitors (to name a few). 1) However, acarbose and voglibose as part of α-glucosidase inhibitors (AGIs) are another class of anti-diabetic medications. As first-line hypoglycemic drugs used in patients with type 2 diabetes especially in Asian since their diet meals contain high content of carbohydrates, acarbose and voglibose can typically reduce postprandial glucose level by delaying carbohydrate digestion in the gut, so they can be a useful treatment in the patients who raised basal glucose concentrations slightly and marked postprandial hyperglycemia. 2) In addition, there will also be some side effects, mainly reflected in gastrointestinal flatulence, loose stool and so on. The main reason for this is that fermentation of undigested carbohydrates by bacteria produced gas in the colon. 3) Acarbose and voglibose treatment delayed starch digestion in the small intestine but there was compensatory salvage through bacterial fermentation in the large intestine. 4) When carbohydrates (starch, dietary fiber) enter the large intestine, they are degraded by the fermentation of anaerobic flora. 5) Under normal diet situations, the better part of starch was digested and absorbed in the small intestine, therefore, extra starch entering the large bowel changed microbial eco-system to some degree. Som...

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“…Acarbose is an effective drug with relatively long safety profile having various cardiovascular and metabolic beneficial effects, it is not associated with hypoglycemia and it promotes weight loss [43][44][45][46][47][48]. Different meta-analysis, review articles and more than 350 studies have reported its efficacy (when used alone or in combination with other antihyperglycemic medications, including metformin), safety profile, cardiovascular, weight reduction, metabolic and other benefits [43][44][45][46][47][48].…”

Section: Acarbosementioning

confidence: 99%

“…Different meta-analysis, review articles and more than 350 studies have reported its efficacy (when used alone or in combination with other antihyperglycemic medications, including metformin), safety profile, cardiovascular, weight reduction, metabolic and other benefits [43][44][45][46][47][48]. Metformin or acarbose is recommended by International Diabetes Federation and American Association of Clinical Endocrinologist when the lifestyle modification strategy is not enough for prevention of type 2 diabetes [21,49].…”

Section: Acarbosementioning

confidence: 99%

Principle of Management of Type 2 Diabetes: From Clinical, Public Health and Research Perspectives

Bhattarai¹

2018

Diabetes and Its Complications

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Apart from stopping smoking, controlling hypertension and using statin, losing possible excess bodyweight and regular physical activity and exercise are the cornerstones in diabetes management. There is often need of controlling blood glucose immediately. Approach of 'dynamic dose management of medications likely to cause hypoglycemia' helps to control high blood glucose immediately as and when required with sulfonylurea or insulin and to taper off their dose later. Anti-hyperglycemic medications which are unlikely to cause hypoglycemia are continued to control hyperglycemia. The diagnosis of gestational diabetes usually made at 24-28 weeks is applicable for clinical management of mother and child and for possible prevention of diabetes later in the mother. From the public health perspectives, however, protection of the susceptible in utero population from maternal malnutrition or clinical or subclinical hyperglycemia right from the time of conception itself also needs to be considered to control the diabetes epidemic at the population level. Campaigns and programmes for maintenance of optimal pre-pregnancy body weight as per the recommended body mass index of the respective populations along with regular physical activity and exercise during pregnancy are the essential measures available at hand to prevent the possibility of maternal hyperglycemia right from the early pregnancy.

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Acarbose: safe and effective for lowering postprandial hyperglycaemia and improving cardiovascular outcomes

Cited by 176 publications

References 169 publications

Postprandial dysmetabolism: Too early or too late?

Postprandial dysmetabolism: Too early or too late?

Comparisons of Effects on Intestinal Short-Chain Fatty Acid Concentration after Exposure of Two Glycosidase Inhibitors in Mice

Principle of Management of Type 2 Diabetes: From Clinical, Public Health and Research Perspectives

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