Drug Therapy of Postprandial Hyperglycaemia

Abstract

It is widely accepted that the most challenging goal in the management of patients with diabetes mellitus is to achieve blood glucose levels as close to normal as possible. In general, normalising postprandial blood glucose levels is more difficult than normalising fasting hyperglycaemia. In addition, some epidemiological studies suggest that postprandial hyperglycaemia (PPHG) or hyperinsulinaemia are independent risk factors for the development of macrovascular complications of diabetes mellitus. Recently, several drugs with differing pharmacodynamic profiles have been developed which target PPHG. These include insulin lispro, amylin analogues, alpha-glucosidase inhibitors and meglitinide analogues. Insulin lispro has a more rapid onset of action and shorter duration of efficacy compared with regular human insulin. In clinical trials, the use of insulin lispro was associated with improved control of PPHG and a reduced incidence of hypoglycaemic episodes. Repaglinide, a meglitinide analogue, is a short-acting insulinotropic agent which. when given before meals, stimulates endogenous insulin secretions and lowers postprandial hyperglycaemic excursions. Both insulin lispro and repaglinide are associated with postprandial hyperinsulinaemia. In contrast, amylin analogues reduce PPHG by slowing gastric emptying and delivery of nutrients to the absorbing surface of the gut. Alpha-Glucosidase inhibitors such as acarbose, miglitol and voglibose also reduce PPHG primarily by interfering with the carbohydrate-digesting enzymes and delaying glucose absorption. With the availability of agents which preferentially reduce postprandial blood glucose excursions, it is now possible to achieve glycaemic goals in a larger proportion of individuals with diabetes mellitus.

α-Glucosidase Inhibitor from the Seeds of Balsam Pear (Momordica charantia) and the Fruit Bodies ofGrifola frondosa

“…NMR spectra were recorded on a Jeol JNM-EX 270 FT-NMR system ( 1 H at 270 MHz; 13 C at 67.5 MHz) (Jeol Datum, Osaka, Japan). In the 1 Materials. Field-grown balsam pears were purchased from Shimajiri farm, Nago, Okinawa prefecture, in October 1999.…”

“…a-Glucosidase inhibitors such as acarbose, miglitol, and voglibose are known to reduce the postprandial hyperglycemia by interfering with the digestion of dietary carbohydrates. 1) This has led to the clinical use of acarbose for the treatment of diabetes mellitus. But users of acarbose are required to consult with doctors because of its side eŠects.…”

Narrative Review: A Rational Approach to Starting Insulin Therapy

“…Many factors affect postprandial hyperglycemia (31,32), including the amount of carbohydrate ingestion and rate of absorption (33), the loss of early-phase insulin secretion (34), the rate of glucagon secretion (33), the effect of these hormones on glucose uptake in muscle, and suppression of hepatic glucose production (35).…”

Molecular Docking and Pharmacokinetic Prediction of Herbal Derivatives as Maltase-Glucoamylase Inhibitor

“…This chronic disease not only affects the carbohydrate metabolism but also alters lipid and protein metabolism in advanced stages, leading to complications such as microvascular or macrovascular which are more fatal than the primary diabetic state; thus, all credit goes to regulating postprandial glucose levels [5][6][7]. One of the therapeutic approaches to regulate blood glucose level in an individual with type 2 diabetes is to inhibit R-amylases and intestinal glucosidases activity using R-glucosidase inhibitors such as acarbose and miglitol [8][9][10].…”