Double‐blind Crossover Study of Acarbose in Type 1 Diabetic Patients

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Abstract
The addition of acarbose to insulin treatment was evaluated in 14 Type 1 (insulin‐dependent) diabetic patients assessed conventionally (blood glucose profile and HbA1c measurement) and with an artificial B‐cell. Their metabolic control was poor, fasting blood glucose 10.7 ± 0.3 (±SE) mmol I−1, mean daily blood glucose 9.7 ± 0.3 mmol I−1, and HbA1c 9.6 ± 0.2% (normal range 5.0–6.1%). They were of normal body weight (body mass index 22.5 ± 0.3 kg m−2), and were C‐peptide deficient (fasting 0.08 ± 0.02 nmol I−1). In addition to their usual insulin therapy (46.9 ± 3.5 U day−1 in three pre‐meal injections), they received 100 mg acarbose or placebo three times a day for 6 weeks in a randomized double‐blind crossover design. On the last day of either acarbose or placebo treatment, the usual insulin therapy was discontinued and an artificial B‐cell was used for insulin delivery, programmed for euglycaemia. Placebo or acarbose was continued before meals. Acarbose reduced mean daily blood glucose concentrations (8.5 ± 0.3 vs 9.7 ± 0.3 mmol I−1, p = 0.002) and HbA1c levels (8.3 ± 0.1 vs 9.6 ± 0.2%, p < 0.001). A significant reduction in insulin requirement after meals was found with the artificial B‐cell, 25.1 ± 2.5 (first treatment acarbose) and 24.1 ± 2.9 U (first treatment placebo) with acarbose and 40.0 ± 2.5 and 35.6 ± 2.9 U with placebo (p < 0.001). These results suggest that acarbose could usefully be administered to Type 1 diabetic patients to ameliorate glucose control and reduce insulin requirement.

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