TREATMENT OF POORLY CONTROLLED NON-INSULIN-DEPENDENT DIABETIC PATIENTS WITH ACARBOSE

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Abstract
Acarbose, 300 mg/day, was administered over 1 mo. in a cross-over trial to 18 hyperglycemic patients aged 41-66 yr with non-insulin-dependent diabetes mellitus (NIDDM). All showed normal or exaggerated insulin release after a glucose challenge and remained in poor control (random glucose levels .gtoreq. 13 mmol/l) despite involvement in a diabetes intervention program and prior use of oral hypoglycemic agents. During the 1 mo. treatment with acarbose, fasting glucose and % HbAl concentrations were not different from those observed during placebo therapy. Furthermore, glucose tolerance was unchanged by acarbose treatment. Glucose concentrations after a 1.6 MJ test meal were reduced by acarbose from peak values of 17.3 .+-. 1.0 to 15.0 .+-. 1.1 mmol/l and were associated with lower post-prandial C-peptide (CPR) and insulin responses. Nevertheless, daily insulin production, as assessed by CPR excretion rates and plasma CPR and insulin concentrations, was not reduced by acarbose. Fasting plasma insulin and CPR levels were significantly higher during acarbose then placebo therapy. Acarbose (100-400 mg/day) was continued for 6 mo. in 12 of these patients. During treatment, post-prandial glucose levels remained lower but montly MBG [mean blood glucose] values, determined by self-measurement of blood glucose, were unchanged except for small reductions in the 4th and 5th treatment month. % HbAl levels did not change. Acarbose treatment of a defined group of patients with poorly controlled NIDDM; evidently resulted in small but sustained reductions of post-prandial glucose levels but without improving glucose tolerance and reduced the circulating concentrations of insulin and CPR postprandially, but overall did not reduce daily production.