Carbohydrate malabsorption following acarbose administration

Abstract

Carbohydrate absorption was assessed during acarbose administration to investigate the actions of this drug. In 7 healthy volunteers, breath hydrogen concentration was measured at 15-min intervals after administration of 6 g of lactulose, and continued until 4 h after the breath hydrogen level exceeded its pretreatment value by > or =10 ppm, then the amount of undigested carbohydrate was calculated following administration of various doses of acarbose and Ensure Liquid. Breath hydrogen data were also obtained before and after administration of acarbose to 8 patients with Type 2 diabetes mellitus for 2 and 4 months. After administration of 50 mg of acarbose with 250 ml or 500 ml of Ensure, the mean amount of unabsorbed carbohydrate was 5.3 g and 7.7 g, respectively, while unabsorbed carbohydrate increased to 10.8 g after 100 mg of acarbose with 500 ml of Ensure. In the diabetic patients, breath hydrogen excretion decreased to 31.6% of baseline after 2 months of acarbose administration, indicating decreased carbohydrate malabsorption. Despite this, the haemoglobin A1c level remained stable after 5 months. In conclusion, the extent of carbohydrate malabsorption depended on the acarbose dose and the carbohydrate load. Although carbohydrate malabsorption decreased with continued acarbose administration, the improvement of glycaemic control was maintained.

Hypoglycemic Effects of Morus alba Leaf Extract on Postprandial Glucose and Insulin Levels in Patients with Type 2 Diabetes Treated with Sulfonylurea Hypoglycemic Agents

“…Adverse events, predominantly gastrointestinal symptoms, have frequently been reported in association with the administration of α-glucosidase inhibitors [23][24][25], though no side-effects resulted from the ingestion of jelly containing LEM in the current study. Kim et al reported that LEM suppressed postprandial glucose levels with few side-effects by α-glucosidase inhibitor [37].…”

“…This indicates fermentation by intestinal microbes of carbohydrates that have escaped digestion in the small intestine and been transferred to the large intestine [21,22]. Hydrogen excretion was also observed when an α-glucosidase inhibitor, such as acarbose or miglitol, was administered to patients with available carbohydrates [23][24][25]. The available energy of nondigestible saccharides has been estimated at 2 kcal/g (8.36 kJ/g) according to the Health Promotion Act in Japan [26,27], which is lower than that of digestible carbohydrates (approximately 4 kcal, 16.72 kJ).…”

Low‐dose acarbose does not delay digestion of starch but reduces its bioavailability

“…Reports about hydrogen excretion due to effects of acarbose are conflicting and depend on the type of carbohydrate in the test meal and the dose of acarbose. Sucrose‐ and dextrimaltose‐containing meals (33–100 g carbohydrates) resulted in hydrogen excretion with 50–200 mg of acarbose [30,31]. After ingestion of starchy meals (50 g carbohydrate) administered with 200 mg acarbose, hydrogen excretion was observed in one [32] but not in another study [33].…”

Glucose Supply and Insulin Demand Dynamics of Antidiabetic Agents

“…The alpha-glucosidase inhibitors (1) have no significant effect on total caloric intake, 22 (2) delay and decrease carbohydrate absorption, [23][24][25][26][27] (3) have not been directly evaluated for HGU, (4) have negligible effect on hepatic glucose output, 28,29 (5) reduce IR, 22,[30][31][32][33] (6) have variable effects on PGU, 22,28,30,[34][35][36][37][38] and (7) reduce plasma insulin concentrations. 22,[39][40][41][42][43][44][45] Studies meeting the review criteria for the target effects of the alpha-glucosidase inhibitors on the respective targets are summarized here.…”

“…These findings are supported by Sobajima et al, where carbohydrate malabsorption, measured by hydrogen excretion following 2-month acarbose administration (50-100 mg three times daily) was estimated to be 31.6% of baseline. 25…”