EFFECT OF ACARBOSE ON BLOOD-GLUCOSE PROFILES AND PLASMA 1,5-ANHYDRO-D-GLUCITOL IN TYPE-2 DIABETES POORLY CONTROLLED BY SULFONYLUREA THERAPY

Sixteen patients with type 2 diabetes poorly controlled by glibenclami de (7.5-10.0 mg/day) were treated with acarbose (100 mg tds) for one w eek and the effect on the blood glucose profile, 24-hour urinary gluco se excretion, plasma fructosamine, and plasma 1,5-anhydro-D-glucitol ( 1,5-AG) level was determined. The blood glucose profile was more stabl e and levels were lower during acarbose administration. In some patien ts, this improvement was maintained after discontinuing acarbose. The hi-value, an indicator of blood glucose fluctuations, decreased signif icantly from 33.2 +/- 3.0 (mean +/- SEM) in the run-in period to 13.4 +/- 2.4 during acarbose therapy (P < 0.001), and rose again to 26.5 +/ - 4.4 (P < 0.001) in the follow-up period. The 24-hour urinary glucose excretion and plasma fructosamine decreased similarly (P < 0.001 and P < 0.01, respectively) during and after acarbose therapy. Plasma 1,5- AG levels did not change significantly during acarbose therapy, but in creased markedly afterwards (from 19.3 +/- 3.1 mu mol(-1) to 25.0 +/- 3.1 mu mol(-1), P < 0.001). Plasma 1,5-AG levels were significantly co rrelated with urinary glucose excretion one week earlier (r = 0.513, P < 0.006). These findings suggest that acarbose may improve glycemic c ontrol in type 2 diabetic patients poorly controlled by sulfonylurea t herapy and that plasma 1,5-AG might be used as a marker of glycemic co ntrol cooperating with other markers such as fructosamine and urinary glucose determination for monitoring the short-term response to antidi abetic therapy.