RELATIONSHIP BETWEEN GASTRIC-EMPTYING AND ON ALPHA-GLUCOSIDASE INHIBITOR EFFECT ON POSTPRANDIAL HYPERGLYCEMIA IN NIDDM PATIENTS

OBJECTIVE - The purpose of the study was to examine the relationship b etween gastric emptying and the efficacy of an alpha-glucosidase inhib itor in NIDDM patients. RESEARCH DESIGN AND METHODS - Sixteen NIDDM pa tients (4 patients treated with diet therapy alone and 12 receiving a sulfonylurea) were given 0.6 mg of voglibose daily for 4 weeks. The ef ficacy of voglibose was assessed by measurement of HbA(1c), fasting pl asma glucose, and 45- and 120-min postprandial plasma glucose (PPG) an d serum insulin concentrations before and after the 4 weeks of voglibo se therapy. Gastric emptying was evaluated using the proportional cumu lative area under the absorption curve (% AUC) of plasma acetaminophen concentration at 60 min after ingestion of a liquid test meal contain ing 20 mg/kg of acetaminophen. These measurements were also taken befo re and after the therapy. RESULTS - The change in the 45-min PPG level s from the fasting state correlated significantly with the % AUC of th e plasma acetaminophen concentrations (r = 0.625, P = 0.0096) before t he voglibose administrations. The mean 45-min and 2-h PPG levels were reduced significantly after 4 weeks of voglibose (P < 0.05 and P < 0.0 1, respectively). Two-hour post prandial serum insulin concentrations were also significantly reduced at the end of the treatment period (P < 0.05). The changes in the PPG levels between pre-and posttreatment p eriods correlated significantly with the % AUC of the plasma acetamino phen concentrations before the treatment period (r = 0.499, P = 0.0490 ; r = 0.713, P = 0.0019, respectively). There was no significant diffe rence in the plasma acetaminophen concentrations between pre-and postt reatment periods. CONCLUSIONS - The rate of gastric emptying affects t he efficacy of voglibose therapy in NIDDM patients. Voglibose did not however alter the rate of gastric emptying.