Efficacy and safety of acarbose in patients with cystic fibrosis and impaired glucose tolerance

Impaired glucose tolerance (IGT) is an increasingly frequent complication o f cystic fibrosis (CF). In CF patients, a fast postprandial rise in plasma glucose is typically followed by a delayed but prolonged insulin response. Patients may develop symptoms of both hyper- and hypoglycaemia. The cc-gluc osidase inhibitor, acarbose, delays the hydrolysis and subsequent absorptio n of ingested carbohydrates. The aim of this study was to investigate the e fficacy of acarbose in CF patients with IGT. During a 2-week inpatient period for treatment of Pseudomonas infection, 12 CF patients with IGT were studied in a double-blinded, randomized crossove r trial. Each patient received acarbose (50 mg t.i.d.) for 5 days and place bo for 5 days (days 3-8 and days 10-14, respectively). Glucose, insulin and C-peptide responses to a standardized nutritional load were measured at ba seline and at the end of each study period (Days 2, 8 and 14). Treatment wi th acarbose was associated with significant reductions in the mean value, m ean peak values and the area under the curve of plasma glucose, insulin and C-peptide, compared to respective baseline values and placebo. Gastro-inte stinal disturbances were recorded in 67% of patients during therapy with ac arbose. Conclusion Acarbose has a positive therapeutic effect on glucose tolerance in cystic fibrosis patients, as shown by attenuation of postprandial plasma glucose increase and a significant decrease in insulin secretion response. However, acarbose treatment was associated with adverse astro-intestinal e ffects that may prevent patients from accepting long-term therapy.