Dose-response profile of acarbose in older subjects with type 2 diabetes

Objective: To examine the dose-response relationship of acarbose, an alpha- glucosidase inhibitor, in older subjects with type 2 diabetes. Research Des ign: Fourteen subjects with type 2 diabetes who were over 65 years old were studied. Five subjects had been treated with diet alone and 9 were receivi ng a sulfonylurea. The subjects underwent a meal tolerance test in the pres ence of varying doses of acarbose (0, 25, 50, and 100 mg) on 4 occasions, e ach 1 week apart. The test meal was chosen to include food items commonly c onsumed during breakfast in the United States. The 483-kcal meal consisted of 51% of calories in the form of carbohydrates, 14% protein, and 35% fat. The serum glucose, insulin, and triglyceride levels were measured at 0, 1, and 2 hours after the meal. Results: The post prandial hyperglycemic respon se to the test meal was significantly reduced with 25 mg of acarbose compar ed with baseline values. Increasing doses of acarbose to 50 or 100 mg had n o significant additional ameliorating effects on postprandial hyperglycemia . Postprandial insulin or triglyceride levels were not significantly altere d with single dose acarbose treatment. Conclusions: It is concluded that th e acute efficacy of acarbose is near maximal at 25 mg when the meal size do es not exceed 483 kcal and contains only 61 gm of carbohydrates.