α-Glucosidase inhibitors are a new class of oral antidiabetic drugs suitable for any type of diabetes. They were developed by Bayer, a German pharmaceutical company, and mainly include acarbose and miglitol. These drugs have broad application prospects and are currently mainly used in economically developed regions.
1.Mechanism of action:
α-Glucosidase inhibitors competitively inhibit the activity of α-glucosidases, including sucrase, maltase, and isomaltase, on the brush border membrane of the small intestine. This inhibition prevents the breakdown of polysaccharides and disaccharides into glucose, delaying the absorption of carbohydrates. They primarily reduce postprandial blood glucose levels and slow down hyperinsulinemia. Long-term use can also lower fasting blood glucose levels, avoiding excessive fluctuations in blood sugar.
2.Hypoglycemic effect:
Moderate to mild. Each 50 mg can reduce postprandial blood glucose by 1.37-2.78 mmol/L.
3.Characteristics of Commonly Used α-Glucosidase Inhibitors:
(1) Acarbose:
Tablet form, each tablet contains 50-100 mg. The usual dosage is 150-300 mg per day, not exceeding 900 mg, taken in three divided doses with meals. Acarbose is minimally absorbed in the intestines and does not affect liver or kidney function. Common side effects include gastrointestinal reactions such as bloating, abdominal rumbling, and nausea, with less frequent occurrence of diarrhea. Acarbose itself does not cause hypoglycemia, but if hypoglycemia occurs when used in combination with other drugs, oral or intravenous glucose should be administered for correction. It is suitable for both type 1 and type 2 diabetes, but caution is advised in patients with severe acute or chronic complications, age <18 years, and during pregnancy and breastfeeding.
(2) Miglitol:
Tablet form, each tablet contains 50 mg. The mechanism of action of miglitol is similar to acarbose, but it is almost completely absorbed in the small intestine. The efficacy and side effects of miglitol are similar to acarbose.