POTENTIAL OF ALPHA-GLUCOSIDASE INHIBITORS IN ELDERLY PATIENTS WITH DIABETES-MELLITUS AND IMPAIRED GLUCOSE-TOLERANCE

The prevalence of diabetes mellitus (DM) among the elderly, who consti tute >20% of the population in developed countries, is high (up to 40% ). Indeed, elderly people represent the bulk (approximate to 50%) of t he diabetic population. There is much evidence that better glycaemic c ontrol can reduce the morbidity associated with this disease. alpha-Gl ucosidase inhibitors are well tolerated in the treatment of DM in this population. They reduce postprandial hyperglycaemia and have a modera te effect on fasting plasma glucose levels, resulting in a significant reduction in glycated haemoglobin (HbA(1C)) levels. alpha-Glucosidase inhibitors can be used either as monotherapy or in combination with o ther oral hypoglycaemic agents or insulin. The good safety profile of these drugs makes them suitable for use in elderly patients with type 2 (non-insulin-dependent) DM, because they can achieve substantial met abolic improvements without any additional risks. Thus, the use of alp ha-glucosidase inhibitors should be considered: (i) as a first-choice treatment in newly diagnosed patients; (ii) in individuals whose DM is not well controlled with any other type of treatment; or (iii) as an alternative to sulphonylureas or biguanides in patients at risk from h ypoglycaemia or lactic acidosis, respectively. Despite the numerous po tential advantages of alpha-glucosidase inhibitors in elderly patients with type 2 DM, there is a lack of studies focusing specifically on t hat population. However, such studies are under way. In addition, the potential of alpha-glucosidase inhibitors in the prevention of type 2 DM and/or on macrovascular disease is currently under study.