ONE-YEAR ACARBOSE TREATMENT RAISES FASTING SERUM ACETATE IN DIABETIC-PATIENTS

alpha-Glucosidase inhibitors such as acarbose improve blood glucose co ntrol in diabetes by delaying or reducing carbohydrate absorption. The fermentation of malabsorbed carbohydrate in the colon is associated w ith the production of gas, leading to flatulence, and short chain fatt y acids such as acetate, which may have systemic effects. To see if ac arbose raised fasting serum acetate in diabetic patients, we studied 8 5 subjects selected from the 267 who had completed a 1-year, double-bl ind, placebo-controlled, parallel design study of the effects of acarb ose in the treatment of diabetes. At baseline, there was no significan t difference between the 44 subjects subsequently randomized to placeb o and the 41 randomized to acarbose, respectively, in fasting serum ac etate (80 +/- 5 vs 71 +/- 4 mu mol l(-1)) or glycosylated haemoglobin (HbA(1c); 7.2 +/- 0.3 vs 7.4 +/- 0.3 %). Compared to placebo, acarbose treatment significantly increased fasting serum acetate by 11 +/- 4 v s 2 +/- 3 mu mol l(-1) (p < 0.02) and reduced HbA(1c) by -0.59 +/- 0.1 6 vs -0.13 +/- 0.20 % (p < 0.02). Acarbose treatment had no significan t effect on serum cholesterol or non-esterified fatty acids, but was a ssociated with a significant increase in flatulence. There was no rela tionship between changes in serum acetate and changes in HbA(1c), seru m cholesterol or symptoms. We conclude, in subjects with diabetes who tolerate therapy for a 1-year period, that acarbose treatment increase s serum acetate. The magnitude of change in acetate was unrelated to s ide-effects or changes in blood glucose control or serum lipids.