Efficacy and Cardiovascular Safety of Alpha Glucosidase Inhibitors

: Alpha Glucosidase Inhibitors (AGIs) are a group of drugs which act on the gastrointestinal tract and help in reducing fasting and postprandial hyperglycemia by reducing the absorption of carbohydrates. This group comprises Acarbose, Miglitol and Voglibose. They are available on the market for almost three decades now. When used as monotherapy, Glycated Haemoglobin (HbA1c) reduction can be as high as 0.77%, which is predominantly noted in the Eastern Asian population and those on a high carbohydrate diet. There is a more pronounced reduction in HbA1c in those who present with higher baseline values. Despite not showing a significant cardiovascular benefit with regards to mortality and morbidity, they have proven to be a safe class of drugs which can be used in patients not tolerating various other anti-diabetic agents due to their local site of action and poor systemic absorption. Though they are available worldwide, AGIs are used more often in the Far East and South Asia. They have shown benefits in reducing the development of diabetes when used in those with impaired glucose tolerance or pre-diabetes. They have been shown to improve postprandial hyperglycemia, which in itself is an independent risk factor for cardiovascular morbidity. These have proven their safety from both cardiovascular and non-cardiovascular perspectives and can be combined with any class of anti-diabetic agents. They are not favoured in most of the current Western Guidelines due to their modest HbA1c reduction, neutrality with cardiovascular benefit as well as their significant gastrointestinal side effect profile.