The use of Acarbose in type 2 diabetic patients in secondary failure: effects on glycaemic control and diet induced thermogenesis

Acarbose, an alpha-glucosidase inhibitor, delays the absorption of complex carbohydrates and sucrose, thereby lowering post-prandial blood glucose. In this study, we evaluated the effects of Acarbose on glycaemic control in T ype 2 diabetic patients in secondary oral hypoglycaemic agent failure. Due to its mode of action, we also used indirect calorimetry to examine its eff ects on energy expenditure (EE), diet induced thermogenesis (DIT) and respi ratory quotient (RQ) after a standard breakfast (440 calories with 60 g car bohydrates). A total of 12 patients (male/female, 8/4; age, 56 +/- 9 years; duration of diabetes 10.1 +/- 4.6 years; body mass index (BMI) 29.6 +/- 2. 7 kg/m(2)) with poor glycaemic control (HbAlc, 8.8 +/- 0.9%) completed 8 we eks treatment with Acarbose (100 mg). After treatment, HbAlc was lower comp ared to the baseline (8.8 +/- 0.9% vs. 8.0 +/- 0.9%; t = 2.7; P = 0.02). Ac arbose acutely lowered post-prandial blood glucose and insulin area under t he curve by a mean of 16.9% and 9.2%, respectively. Long term changes in Hb Alc correlated strongly with acute changes in blood glucose area due to Aca rbose administration (r = 0.87; P < 0.01). There was a significant effect o f Acarbose on EE and DIT for the first 120 min post meal (F-3.92 = 3.4; P = 0.03, F-2.69 = 6.3; P = 0.008, respectively). After Acarbose treatment, RQ was lower at 30 min compared to the baseline (0.86 +/- 0.04 before, and 0. 83 +/- 0.05 after; t = 2.8; P = 0.02). In conclusion, Acarbose improves gly caemic control and changes post-prandial energy expenditure of Type 2 diabe tic patients in secondary failure. The magnitude of long term reduction in hyperglycaemia differs amongst individuals. This is largely due to intrinsi c variations in patients' response to Acarbose rather than differences in m edication compliance or dietary composition. (C) 1998 Elsevier Science Irel and Ltd. All rights reserved.