Influence of acarbose on post-prandial insulin requirements in patients with Type 1 diabetes

The primary objective of this double-blind, placebo-controlled, randomised cross-over study was to investigate the influence of acarbose on insulin re quirement in patients with Type 1 diabetes (TIDM) following a standardised meal. Tn addition, the study assessed the effects of acarbose on post-prand ial triglyceride, glucagon and gastrointestinal peptide levels, gastric emp tying, and oxidative glucose metabolism, Following normalisation of their b lood glucose, 10 patients received a standardised meal together with acarbo se (100 mg) or placebo. Each patient was evaluated twice (separated by 10+/ -3 days), and the crossover study design ensured that they received both ac arbose and placebo. The insulin requirement for maintenance of normoglycaem ia was assessed using a closed-loop insulin infusion system (artificial pan creas, Biostator(R)), Acarbose produced a statistically significant reducti on in mean insulin requirement over a 3-hr period following the meal compar ed with placebo (5171.7+/-2282.6 mU vs 8074.5+/-3045.4 mU; p=0.003). The le vel of blood glucose control over the same period was similar in the two gr oups. Gastric inhibitory polypeptide levels also showed a statistically sig nificant decrease with acarbose treatment compared with placebo for AUC (ar ea under the curve; p=0.006) and C-max (maximum plasma concentration; p=0.0 22), but not t(max) (time to reach C-max from the start of the standardised meal; p>0.05). Analysis of the other efficacy parameters revealed no stati stically significant differences between acarbose treatment and placebo (p> 0.05). These results indicate that acarbose decreases insulin requirement i n patients with T1DM without affecting gastric emptying, Diab. Nutr. Metab. 13:7-12, 2000. (C) 2000, Editrice Kurtis.