Alpha-Glucosidase Inhibitors

Summary

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Key Points

• Alpha (α)-glucosidase inhibitors
  • Drug Names
    • Acarbose
    • Miglitol
  • Mechanism
    • Inhibit alpha (α)-glucosidases at intestinal brush-border
      • Decreased carbohydrate hydrolysis (breakdown)
        • Prevents breakdown of disaccharides into simple sugars that can be absorbed by the intestines
      • Decreased intestinal absorption of glucose
        • Decreased postprandial hyperglycemia
  • Clinical Use
    • Treats diabetes mellitus
      • Typically used with refractory type 2 diabetes mellitus
  • Side Effects
    • Flatulence and Diarrhea
      • Flatulence, bloating, diarrhea caused by the fermentation of unabsorbed carbohydrates
    • Use with Caution in Renal Insufficiency (not recommended)
      • Especially with Miglitol, since miglitol is absorbed systemically and excreted unchanged in the urine. Poor kidney function can therefore lead to increased doses and side effects
      • Acarbose is metabolized nearly completely within the gastrointestinal tract, so very little is excreted in the urine.
    • Weight neutral
      • No effect on weight
    • Does not cause hypoglycemia
      • Since this drug does not cause insulin release, the risk of hypoglycemia is low when used in isolation
      • This drug may slightly increase the risk of hypoglycemia when it is taken together with insulin or insulin-releasing drugs