Effects of the addition of acarbose to insulin and non-insulin regimens in veterans with type 2 diabetes mellitus

Abstract

Objectives:The primary objective of the study was to assess the mean change in hemoglobin A1c (HbA1c) when acarbose was added to insulin and non-insulin regimens in patients with type 2 diabetes mellitus (T2DM). Secondary objectives were to evaluate the discontinuation rate of acarbose, and to assess the number of patients who were placed on insulin despite the addition of acarbose.Methods:A retrospective chart review was conducted on veterans with T2DM initiated on acarbose between October 1, 2013 and December 31, 2013. To be included, patients must have had a refill history indicating at least 3 months of acarbose use and HbA1c readings within 6 months prior to initiation and after at least 3 months of use. Excluded patients were those with type 1 diabetes mellitus, serum creatinine ≥2 mg/dL at acarbose initiation, or a diagnosis based on ICD-9 codes for an existing gastrointestinal condition or liver cirrhosis. The two-tailed, paired t-test was used for analysis of the primary objective and descriptive statistics were used for all other outcomes.Results:Of the 146 patients screened, 102 patients were included in the study. Exclusions were primarily due to patients not being on acarbose for at least 3 months (n=43). The average HbA1c before and after acarbose initiation was 9.08% (SD=1.74) and 8.43% (SD=1.74) respectively, with an average HbA1c reduction of 0.65% (n=102, p=0.0005). Forty patients (39.2%) discontinued acarbose after at least 3 months of use. Of the 73 patients not on insulin at the time of acarbose initiation, 19 (26%) were started on insulin therapy despite addition of acarbose.Conclusion:Acarbose can be considered in patients who may reach their HbA1c goal with minimal HbA1c reduction. However, adverse effects are a limitation to use. Potential risks and benefits should be assessed and discussed with the patient prior to prescribing acarbose.

Efficacy and Safety of Mulberry Twig Alkaloids Tablet for the Treatment of Type 2 Diabetes: A Multicenter, Randomized, Double-Blind, Double-Dummy, and Parallel Controlled Clinical Trial

“…GDs are the main side effects of acarbose. In our study, the incidence of GDs in the acarbose group (24.6%) was similar to that in previous reports (5,21,22,28,29,31,32,35). The incidence of GDs in the SZ-A group was 12.2%, which was much lower than the acarbose group, showing a significant difference.…”

“…People in East Asia usually rely on starchy foods as their main source of calories; therefore, a-glucosidase inhibitors are often used as the first-line drug for the treatment of patients with diabetes in this region (18)(19)(20). However, these drugs are associated with a high incidence of gastrointestinal disorders (GDs), such as abdominal distension, abdominal pain, and diarrhea, because of low selectivity to a-glucosidase (5,21,22). In vitro experiments have shown that SZ-A imparts a significant inhibitory effect on sucrase and maltase, which is equal to or slightly stronger than that of acarbose.…”

Synthesis of Rosmarinic Acid Amides as Antioxidative and Hypoglycemic Agents

“…α-Glucosidase inhibition is an established protocol for diabetes therapy, although some commercially available drugs based on carbohydrate-related structures, such as acarbose, voglibose, and miglitol have shown certain side effects . In particular, acarbose is employed as a last-line treatment for T2DM, and when this drug is administered in association with a high-carbohydrate diet, patients complain of flatulence, abdominal cramps, liver problems, lactic acidosis, nausea, and diarrhea. , Thus, there is an active search for new and effective α-glucosidase inhibitors with negligible undesirable side effects . In this context, special attention has been devoted to inhibitors of natural origin, possibly showing significant antioxidative properties.…”

Evaluation of Phenolic Phytochemical Enriched Commercial Plant Extracts on the In Vitro Inhibition of α-Glucosidase

“…Acarbose is considered a last-line intervention treatment for T2DM ( 8 ). The two sugar units within the structure of the compound form the functional inhibitory site that binds to α-glucosidases in the small intestine and α-amylase in the pancreas ( 9 ).…”

“…The two sugar units within the structure of the compound form the functional inhibitory site that binds to α-glucosidases in the small intestine and α-amylase in the pancreas ( 9 ). Due to the mechanistic nature of acarbose, patients complained of gastrointestinal discomfort, flatulence, abdominal cramps, nausea, and diarrhea when using acarbose and consuming a high carbohydrate diet ( 8 ).…”