Double‐blind Crossover Study of Acarbose in Type 1 Diabetic Patients

Abstract

The addition of acarbose to insulin treatment was evaluated in 14 Type 1 (insulin-dependent) diabetic patients assessed conventionally (blood glucose profile and HbA1c measurement) and with an artificial B-cell. Their metabolic control was poor, fasting blood glucose 10.7 +/- 0.3 (+/- SE) mmol l-1, mean daily blood glucose 9.7 +/- 0.3 mmol l-1, and HbA1c 9.6 +/- 0.2% (normal range 5.0-6.1%). They were of normal body weight (body mass index 22.5 +/- 0.3 kg m-2), and were C-peptide deficient (fasting 0.08 +/- 0.02 nmol l-1). In addition to their usual insulin therapy (46.9 +/- 3.5 U day-1 in three pre-meal injections), they received 100 mg acarbose or placebo three times a day for 6 weeks in a randomized double-blind crossover design. On the last day of either acarbose or placebo treatment, the usual insulin therapy was discontinued and an artificial B-cell was used for insulin delivery, programmed for euglycaemia. Placebo or acarbose was continued before meals. Acarbose reduced mean daily blood glucose concentrations (8.5 +/- 0.3 vs 9.7 +/- 0.3 mmol l-1, p = 0.002) and HbA1c levels (8.3 +/- 0.1 vs 9.6 +/- 0.2%, p less than 0.001). A significant reduction in insulin requirement after meals was found with the artificial B-cell, 25.1 +/- 2.5 (first treatment acarbose) and 24.1 +/- 2.9 U (first treatment placebo) with acarbose and 40.0 +/- 2.5 and 35.6 +/- 2.9 U with placebo (p less than 0.001). These results suggest that acarbose could usefully be administered to Type 1 diabetic patients to ameliorate glucose control and reduce insulin requirement.

Pharmacokinetic-Pharmacodynamic Relationships of Acarbose

“…Some researcher have also observed a need for insulin dosage reduction, with an insulin-sparing effect quantified as 35% [68]or as an average of 5 to 7 units daily.l69]…”

Glucose-Lowering Therapy beyond Insulin in Type 1 Diabetes: A Narrative Review on Existing Evidence from Randomized Controlled Trials and Clinical Perspective

“…Acarbose 3 352 185 195 1991 [43], 1997 [44], 1999 [45] 2015 [80], 2017 [81], 2018 (2×) [82,83], 2019 [84],…”

Acarbose Partially Inhibits Microvascular Retinopathy in the Zucker Diabetic Fatty Rat (ZDF/GmiTM-fa)

“…The most important clinical effect is postulated to be improved metabolic control through blunting of postprandial blood glucose level peaks (11)(12)(13)(14)(15), although complex effects on gastrointestinal hormones, serum lipids, somatostatin and C-peptide levels are also found in animal and human studies (8,13,(16)(17)(18). Short-and long-term studies in humans have demonstrated easier metabolic management of diabetic patients with more favorable blood glucose profiles resulting from acarbose administration in both type 1 and type 2 diabetes (10,(19)(20)(21)(22)(23). No study has determined the effects of acarbose administration on diabetic retinopathy in humans.…”

“…Acarbose (Precose™; Bayer; West Haven, CT) is an orally administered alpha glucosidase inhibitor which specifically competes with disaccharide and starch binding to oligosaccharidases in the duodenum (6)(7)(8)(9). Approved by the United States Food and Drug Administration for treatment of non-insulin dependent diabetes, this drug has minimal systemic absorption, low toxicity, and it is effective in small doses as a dietary additive (8,10,11). The most important clinical effect is postulated to be improved metabolic control through blunting of postprandial blood glucose level peaks (11)(12)(13)(14)(15), although complex effects on gastrointestinal hormones, serum lipids, somatostatin and C-peptide levels are also found in animal and human studies (8,13,(16)(17)(18).…”