Acarbose and Alpha Glucosidase Inhibitors

Alpha glucosidase inhibitors are a class of oral antidiabetic drugs that delay the digestion and absorption of carbohydrates in the small intestine. They are effective at reducing postprandial hyperglycaemia, producing clinically modest but statistically significant reductions in glycated haemoglobin, with a low risk of hypoglycaemia and minimal effects on body weight. Gastrointestinal side effects are common and in many parts of the world these side effects limit the use of these drugs in routine clinical practice. They are widely used as a treatment for type 2 diabetes in parts of the world where the diet is high in complex carbohydrates, such as China, India and Japan. Acarbose was the first available alpha-glucoside inhibitor and is still frequently used in South and East Asia. It was hypothesised that by reducing postprandial hyperglycaemia acarbose would reduce the incidence of cardiovascular events in people with diabetes or prediabetes. The ACE (Acarbose Cardiovascular Evaluation) trial, which compared acarbose and placebo in 6522 Chinese patients with coronary heart disease and impaired glucose tolerance, showed that acarbose had no effect on major adverse cardiovascular events but reduced the risk of new-onset diabetes by 18%, and alpha glucosidase inhibitors are licensed in some countries for the prevention of diabetes.