Alpha-glucosidase Inhibitors - Diabetes and Alpha-glucosidase inhibitors

Alpha-glucosidase Inhibitors
December 2007
Drug Digest

Alpha-glucosidase inhibitors (AGIs) are one of the many possible treatment options for Type 2 diabetes. AGIs are given with meals and work by slowing the breakdown of the complex sugars into glucose. This results in delayed glucose absorption and lower blood sugars following meals. The AGIs may be used alone or in combination with other medications for diabetes. Glyset and Precose are the only available AGIs. Glyset is only indicated for combination therapy with a sulfonylurea, while Precose may be used with a sulfonylurea, metformin, or insulin.

Drugs in this Class
Acarbose ( Precose )
Miglitol Tablets ( Glyset Tablets )

Summarizing the Evidence

* Currently there are no fully published head-to-head trials directly comparing Precose to Glyset. One partially published trial (published in summary form only) has shown the two medications to be similar in their ability to lower blood glucose levels after meals and in their ability to lower HbA1c levels ("hemoglobin - A1c" is a blood test that measures long-term diabetic control).

* Gastrointestinal (GI) side effects often limit the use of AGIs. Both AGIs can cause comparable GI side effects. Common GI side effects of both drugs include stomach pain, diarrhea, and flatulence or gas.

* The AGIs, when compared to the other diabetic medications, have the least overall effect on HbA1c levels when used alone. The primary use for the AGIs is to lower blood sugar levels after eating. The AGIs have only a minimal effect on fasting blood sugar levels.

* While the AGIs are not the most effective class of diabetic medications, they do have some benefits. They typically do not cause low blood sugar symptoms that can occur with other diabetes medications. They typically are not associated with weight gain (some of the other diabetes medications are associated with weight gain). And by lowering after meal blood sugar levels, the AGIs may be useful in preventing development of diabetic complications and death due to heart-related disorders that have been associated with elevations in blood sugars after meals.

* Since the AGIs are similarly effective, the choice of which to use generally depends on your doctor's preference and/or your prescription benefits formulary.

Dosing and Administration

* Both Glyset and Precose are taken three times daily with the start (first bite) of each main meal. Dosages must be individualized based on effectiveness and tolerance of side effects. Both Glyset and Precose are typically started at the lowest possible dose and increased slowly over 1-2 months to minimize the GI side effects.

Generic Availability

* Neither Glyset nor Precose are currently available in generic formulations.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

1. Glyset [package insert]. Kalamazoo, MI: Pharmacia & Upjohn Company; October 2004.
2. Precose [package insert]. West Haven, CT: Bayer Corporation; November 2004.
3. Rybka J, Goke B, Sissmann J. European comparative study of 2 ??!Vglucosidase inhibitors, miglitol and acarbose [abstract]. Diabetes. 1998;48 Suppl 1:101.
4. Scott LJ, Spencer CM. Miglitol. A review of its therapeutic potential in type 2 diabetes mellitus. Drugs. 2000;59(3):521-549.
5. Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes. Scientific review. JAMA. 2002;287(3):360-372.
6. Campbell LK, Baker DE, Campbell RK. Miglitol: assessment of its role in the treatment of patients with diabetes mellitus. Ann Pharmacother. 2000;34:1291-1301.
7. Hanefeld M, Temelkova-Kurktschiev T. Control of post-prandial hyperglycemia !V an essential part of good diabetes treatment and prevention of cardiovascular complications. Nutr Metab Cardiovasc Dis. 2002;12:98-107.
8. Chiasson JL, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance (The STOP-NIDDM Trial). JAMA. 2003;290(4):486-494.
9. Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M. Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J. 2004;25(1):10-16.
10. Feld S, Hellman R, Dickey RA, et al. The American Association of Clinical Endocrinologists medical guidelines for the management of diabetes mellitus: The AACE system of intensive diabetes self-management !V 2002 update. Endocr Pract. 2002;8(Suppl 1): 40-82. Accessed on 09/08/2006. Available at: http://www.aace.com/pub/pdf/guidelines/diabetes_2002.pdf.