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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This double-blind, placebo-controlled, cross-over study investigated whether acarbose therapy enables patients with Type 1 diabetes to administer insulin injections at the same time as meals without adverse glycaemic consequences, thus negating the need for an injection-meal interval (IMI). The valid-case population was 15. All patients were well controlled on insulin therapy and diet. Each patient underwent four 14-d treatment sequences: IMI of 0 min+acarbose; IMI of 30 min + acarbose; IMI of 0 min + placebo; IMI of 30 min + placebo. There was a 1-wk, placebo-controlled washout period between each treatment. A 50 mg acarbose or placebo tablet was taken with each of three meals for the first 3 d of each treatment; this was increased to 100 mg three times daily on the remaining 11 d. Blood samples were taken between 08.00 and 09.00 h at the end of each treatment sequence, during the fasting state and at the following times after breakfast: 30, 60, 120 and 180 min. The primary target variable was 1-hr postprandial blood glucose level after 14 d. The mean increase in 1-hr postprandial blood glucose level using an IMI of 0 min + acarbose was 51.1+/-53.2 mg/dl, compared with 46.6+/-50.4 mg/dl using a 30-min IMI + placebo. Data provided strong evidence that acarbose prevents the marked increase in postprandial glucose level normally observed when insulin is administered with a meal. Acarbose may thus be useful for patients with Type 1 diabetes who find IMIs inconvenient.
Diabetes Nutr Metab 1999 Jun
PMID:Use of acarbose for eliminating the interval between meal consumption and insulin injection in patients with Type 1 diabetes. 1055 2

Epidemiologic and interventional studies have led to lower treatment targets for type 2 diabetes (formerly known as non-insulin-dependent diabetes), including a glycosylated hemoglobin level of 7 percent or less and a before-meal blood glucose level of 80 to 120 mg per dL (4.4 to 6.7 mmol per L). New oral medications make these targets easier to achieve, especially in patients with recently diagnosed diabetes. Acarbose, metformin, miglitol, pioglitazone, rosiglitazone and troglitazone help the patient's own insulin control glucose levels and allow early treatment with little risk of hypoglycemia. Two new long-acting sulfonylureas (glimepiride and extended-release glipizide) and a short-acting sulfonylurea-like agent (repaglinide) simply and reliably augment the patient's insulin supply. Combinations of agents have additive therapeutic effects and can restore glucose control when a single agent is no longer successful. Oral therapy for early type 2 diabetes can be relatively inexpensive, and evidence of its cost-effectiveness is accumulating.
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PMID:Oral pharmacologic management of type 2 diabetes. 1060 95

This 24-months, placebo-controlled, double-blind, randomised, group comparison study investigated the effect of acarbose vs placebo for improving metabolic control in patients with Type 2 diabetes under dietary training insufficiently controlled by diet alone. Patients randomised to acarbose had their dose increased in a stepwise manner to week 5. From week 5 onwards, they received 100 mg three times daily. This incremental dosing scheme was matched in the placebo group. All patients received specialist, intensive, continuous dietary training and counselling throughout the 2 yr of the study. Of the 74 patients randomised, 60 were included in the per-protocol analysis (28 receiving acarbose; 32 receiving placebo). HbA1c was the primary target variable. Per-protocol analysis found that, after 24 months, the mean difference in HbA1c relative to baseline value was -1.71+/-1.6% in the acarbose group and -0.82+/-1.1% in the placebo group. End-point values were 6.85+/-1.7% in the acarbose group and 7.41+/-1.1% in the placebo group. This difference between acarbose and placebo was statistically significant (p=0.02). Patients were defined as responders if they did not require additional treatment with an antidiabetic agent during the study. The responder rate under acarbose therapy was 89%, compared with 47% for placebo (p=0.0005). Acarbose-treated responders improved their HbA1c level to 6.45+/-0.82% after 24 months. The efficacy of acarbose was consistent throughout the study; decreasing efficacy was not evident. The results demonstrate the efficacy of acarbose for improving metabolic control in patients with Type 2 diabetes, even when such patients receive good dietary treatment and counselling.
Diabetes Nutr Metab 1999 Aug
PMID:Effects of acarbose treatment in Type 2 diabetic patients under dietary training: a multicentre, double-blind, placebo-controlled, 2-year study. 1078 54

The primary objective of this double-blind, placebo-controlled, randomised cross-over study was to investigate the influence of acarbose on insulin requirement in patients with Type 1 diabetes (T1DM) following a standardised meal. In addition, the study assessed the effects of acarbose on post-prandial triglyceride, glucagon and gastrointestinal peptide levels, gastric emptying, and oxidative glucose metabolism. Following normalisation of their blood glucose, 10 patients received a standardised meal together with acarbose (100 mg) or placebo. Each patient was evaluated twice (separated by 10+/-3 days), and the cross-over study design ensured that they received both acarbose and placebo. The insulin requirement for maintenance of normoglycaemia was assessed using a closed-loop insulin infusion system (artificial pancreas, Biostator). Acarbose produced a statistically significant reduction in mean insulin requirement over a 3-hr period following the meal compared with placebo (5171.7+/-2282.6 mU vs 8074.5+/-3045.4 mU; p=0.003). The level of blood glucose control over the same period was similar in the two groups. Gastric inhibitory polypeptide levels also showed a statistically significant decrease with acarbose treatment compared with placebo for AUC (area under the curve; p=0.006) and Cmax (maximum plasma concentration; p=0.022), but not tmax (time to reach Cmax from the start of the standardised meal; p>0.05). Analysis of the other efficacy parameters revealed no statistically significant differences between acarbose treatment and placebo (p>0.05). These results indicate that acarbose decreases insulin requirement in patients with T1DM without affecting gastric emptying.
Diabetes Nutr Metab 2000 Feb
PMID:Influence of acarbose on post-prandial insulin requirements in patients with Type 1 diabetes. 1082 17

Prevention of the onset or worsening of microalbuminuria by good blood glucose control has been confirmed in Type 2 diabetes, though not at the stage of chronic renal failure (CRF). Thus, it would seem desirable to maintain strict blood glucose control whenever circumstances allow. If prescribed sulphonylureas (SU) are effective, they can be continued at adjusted doses until an advanced stage of CRF, subject to strict monitoring. SU are eliminated by the liver, but their metabolites (often active) are eliminated to varying degrees by the kidney. Non-SU insulin secretagogues and thiazolidinediones metabolised by the liver might also be used. The fate of their metabolites (some active) remains to be defined in CRF, and further clinical trials are required. Acarbose and its metabolites, as well as miglitol, very probably accumulate in CRF, causing ill-defined (but especially hepatic) iatrogenic risks. Although the danger of metformin in diabetic patients with renal failure is currently uncertain, CRF remains a regulatory contraindication. Insulin, which is necessary in most Type 2 diabetic patients with CRF, decreases as CRF progresses and when dialysis is started. The kinetics of insulin analogs are modified in CRF. Regardless of the choice of treatment, specialist and regular monitoring is required.
Diabetes Metab 2000 Jul
PMID:Management of drugs affecting blood glucose in diabetic patients with renal failure. 1092 77

Acarbose reduces the intestinal absorption of dietary carbohydrate, thereby ameliorating postprandial hyperglycemia in diabetes mellitus. Dietary carbohydrate can modulate the bioavailability of some trace minerals like zinc and copper. Deficiencies in these minerals are associated with glucose intolerance. It is still unknown whether acarbose's reduction of intestinal carbohydrate absorption causes the short supply of these minerals. Thus, we investigated the changes in plasma zinc and copper levels in patients with NIDDM, after administration of acarbose for 3 months. The results showed that acarbose did not significantly affect fasting and postprandial plasma levels of these minerals, even after acarbose withdrawal. This study indicated that acarbose administration in NIDDM patients over a 3-month period does not influence plasma levels of zinc or copper.
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PMID:Effect of acarbose administration on plasma concentrations of zinc and copper in patients with NIDDM. 1093 49

This paper presents the baseline epidemiological data from 5548 patients with type 2 diabetes enrolled in a French observational study that aims to examine the safety, tolerability and use of acarbose as prescribed by general practitioners (GPs). Patients were recruited and monitored by a representative sample of GPs. Recruitment did not depend on a patient's suitability for acarbose treatment. The data revealed that the mean age of the patient population was 63 years, and that more than 50% of patients were over 65 years old. The population was markedly overweight [mean body mass index(BMI): males, 28.4 kg/m(2); females, 29.1 kg/m(2)] and the mean duration of diabetes was 10 (+/-7.3) years. Over 37% of patients had at least one diabetic complication, and the frequency of complications increased with both age and the duration of diabetes. The most frequently reported complications were cardiac (17.8%), vascular (14.5%) and ocular (12%). At recruitment, almost 90% of patients were being treated with oral antidiabetic agents (OADs). Sulphonylureas (74%) and biguanides (50%) were the most commonly prescribed agents. Acarbose was used to treat 17% of patients and 1% were receiving insulin. GPs set glycaemic treatment goals for 44% of patients in the study. Fasting glycaemia was the primary goal for 37% of the total study population, and HbA(1c) levels for 21% of patients. Postprandial glycaemia was generally given as a secondary or tertiary goal. In conclusion, this study provides the most up-to-date epidemiological data for patients with type 2 diabetes in France.
J Diabetes Complications
PMID:Epidemiological analysis of patients with Type 2 diabetes in France. 1111 85

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8%) did not complete the study and were excluded from further analysis. Six (13%) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n = 15), [Gp B], oral hypoglycaemic agents, OHAs (n = 17), [Gp C], or insulin (n = 8), Gp D]. In addition, during the run-in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3-month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 +/- 1.1 to 8.4 +/- 0.9 (p < 0.027) and, from 11.0 +/- 1.0 to 8.7 +/- 0.7 (p < 0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 +/- 1.1% to 12.2 +/- 1.0% (p < 0.016) in Gp B, from 14.9 +/- 1.1 to 11.9 +/- 1.1% (p < 0.002) in Gp C, and from 14.1 +/- 1.4 to 11.8 +/- 1.4 (p < 0.02) in Gp D. Twenty-three per cent (23%) of the patients experienced flatulence; 7.5%, changes in bowel habits and 5%, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.
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PMID:The efficacy of acarbose in type 2 diabetes mellitus in Jamaica. 1121 36

Acarbose has been shown to reduce postprandial hyperglycemia and to improve lipid parameters in diabetics via its inhibitory effects on intestinal alpha-glucosidases. Response to acarbose may therefore be dependent upon gastric or pancreatic hormone function. To test this hypothesis, we treated 27 mild type 2 (NIDDM) Japanese diabetics who were mildly obese with low-dose acarbose (150 mg/day) for 3 months. We then performed a responder analysis to determine specific hormonal responses that may be associated with a good response to acarbose. At the end of the treatment period, a total of 15 evaluable patients was grouped as responders (n=6) and nonresponders (n=9) based on an effective decrease in postprandial glucose levels (>30 mg/day) and glycosylated hemoglobin (HbA1c) levels (>0.5%). There were no differences between the two groups in demographic variables or mean postprandial glucose levels at baseline. There was a small but significant increase in postprandial cholecystokinin (CCK) in responders, and fasting gastric inhibitory peptide (GIP) levels were significantly increased in responders and all patients after treatment. Serum leptin levels were reduced by treatment in our mildly obese responders and this was associated with a significant decrease in body weight. These results suggest that treatment with low-dose acarbose may reduce hyperglycemia in mild type 2 Japanese patients and may improve metabolic control by regulating hormones involved in glycemic control and digestive absorption. Acarbose may provide a safe adjunct to help treat insulin resistance in type 2 patients.
J Diabetes Complications
PMID:Secretion of GIP in responders to acarbose in obese Type 2(NIDDM) patients. 1152 98

Glibenclamide inhibits the opening of vascular ATP-sensitive potassium (K(ATP)) channels, which represents a protective mechanism during ischaemia. This effect may imply harmful cardiovascular effects of glibenclamide when used under conditions of ischaemia in patients with Type II diabetes. Acarbose is not associated with effects on the cardiovascular system, because the drug is not absorbed from the bowel. Therefore we hypothesized that treatment of Type II diabetes patients with glibenclamide will impair the vasodilator function of K(ATP) opening, unlike treatment with acarbose. A double-blind randomized cross-over study in 12 patients with Type II diabetes was performed to compare the effects of glibenclamide with those of acarbose on the vasodilator responses to K(ATP) channel opening in the forearm vascular bed. The study consisted of two periods: 8 weeks of treatment with orally administered glibenclamide (10 mg x day(-1)) followed by 8 weeks of treatment with acarbose (300 mg x day(-1)), or vice versa. At the end of each treatment period, forearm blood flow (venous occlusion plethysmography) in response to intra-arterially administered diazoxide, acetylcholine and dipyridamole and to forearm ischaemia was measured. The diazoxide-mediated increase in the forearm blood flow ratio (infused/control arm) was significantly less pronounced after glibenclamide than after acarbose (290 +/- 58% and 561 +/- 101% respectively; P<0.0005). Forearm blood flow responses to acetylcholine, dipyridamole and forearm ischaemia were similar during glibenclamide and acarbose treatment. Thus, in patients with Type II diabetes mellitus, treatment with glibenclamide is associated with an attenuated response to K(ATP) opening as compared with treatment with acarbose. This implies that glibenclamide may affect defensive mechanisms under conditions of K(ATP) channel activation.
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PMID:Vascular K(ATP) channel blockade by glibenclamide, but not by acarbose, in patients with Type II diabetes. 1186 71


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