Drugs for diabetes: part 4 acarbose

Acarbose is an alpha-glucosidase inhibitor acting in the gastrointestinal tract producing modest reductions in postprandial hyperglycaemia, with negligible risk of hypoglycaemia and weight gain. In a subgroup of the United Kingdom Prospective Diabetes Study (UKPDS), acarbose showed glycaemic benefits irrespective of the type of concomitant therapy. Acarbose was shown to produce a significant reduction in the progression to diabetes in patients with impaired glucose tolerance in the Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) trial, and in a post-hoc analysis of STOP-NIDDM a reduction in cardiovascular events was observed. Gastrointestinal side effects are the main limiting factor in clinical practice, leading to high rates of non-compliance and discontinuation.