OVERVIEW

Acarbose is an oral medication used to manage blood sugar levels in people with type 2 diabetes. It works by inhibiting enzymes in the intestines that break down carbohydrates, which slows the digestion of starches and sugars. This helps prevent the rise in blood sugar levels after meals.

DOSAGE

MECHANISM OF ACTION

Enzyme Inhibition

Acarbose inhibits the activity of alpha-glucosidase and alpha-amylase enzymes in the small intestine. These enzymes are responsible for breaking down complex carbohydrates (starches) into simple sugars (monosaccharides) like glucose.

Delayed Carbohydrate Absorption

By inhibiting these enzymes, Acarbose slows down the digestion and absorption of carbohydrates. As a result, the conversion of starch to glucose is delayed, causing a gradual rise in blood sugar levels rather than a rapid increase.

Decreased Postprandial Hyperglycemia

This delayed absorption helps reduce post-meal hyperglycemia, a common problem in people with type 2 diabetes. By controlling blood sugar levels after meals, acarbose contributes to overall glycemic control.

Lack of insulin stimulation

Acarbose does not stimulate insulin secretion, making it a unique option for patients who cannot tolerate other medications that increase insulin levels.

SIDE EFFECTS

Gastrointestinal Issues

• Flatulence: Increased gas production is one of the most common side effects.
• Diarrhea: Diarrhea may occur, especially when the medication is started or the dose is increased.
• Abdominal pain: Abdominal discomfort or cramps may occur.
• Borborygmi: Gurgling or gurgling sounds in the abdomen due to increased gas production.

Hypoglycemia

While acarbose itself does not cause hypoglycemia, it can increase the effects of other antidiabetic medications (such as sulfonylureas or insulin), which can lower blood sugar levels. Symptoms may include sweating, trembling, confusion, and dizziness.

Elevated Liver Enzymes

In rare cases, acarbose may cause an increase in liver enzyme levels. Regular monitoring of liver function is recommended, especially during the first few months of treatment.

Allergic Reactions

Although it is rare, some individuals may experience allergic reactions such as rashes, itching or swelling.

DRUG-DRUG INTERACTIONS

Insulin and Sulfonylureas

• Effects: Acarbose may enhance the hypoglycemic effect of these drugs, increasing the risk of hypoglycemia.
• Recommendation: Monitor blood sugar levels closely and adjust the dose of insulin or sulfonylurea as needed.

Other Antidiabetic Agents

• Metformin: Can be used with acarbose; however, close monitoring is advised for any additional effects on blood sugar levels.
• Thiazolidinediones: These can also be combined, but caution is important as they may affect insulin sensitivity.

Digestive Enzyme Supplements

• Effects: Acarbose may interfere with the effectiveness of digestive enzymes (such as pancrelipase) because it slows down carbohydrate digestion.
• Recommendation: Exercise caution and consult a healthcare professional if both drugs are needed.

Antibiotics

• Effects: Certain antibiotics such as rifampin may alter the gut flora and affect the effectiveness of acarbose.
• Recommendation: Monitor glucose levels when starting or stopping antibiotics.

Bile Acid Sequestrants

• Effects: Drugs such as cholestyramine may bind to acarbose, reducing its absorption and efficacy.
• Recommendation: Allow several hours between administration of acarbose and bile acid sequestrants.

Dietary changes

Sudden changes in diet, especially in carbohydrate intake, may affect the efficacy of acarbose and cause gastrointestinal side effects.

Caution in kidney failure

If a patient has kidney failure, they may be at increased risk of side effects, and careful monitoring of blood sugar levels is necessary.

USE

Management of type 2 diabetes

• Postprandial glucose control: Acarbose is particularly effective in controlling blood sugar levels after meals by delaying the digestion and absorption of carbohydrates (postprandial hyperglycemia).
• Combination therapy: It may be used alone or with other antidiabetic drugs (such as metformin, insulin, or sulfonylureas) to achieve better overall glycemic control.

Prevention of Diabetes

At-Risk Populations: As part of an overall strategy to prevent the onset of diabetes, acarbose may be prescribed to individuals with impaired glucose tolerance or those at high risk of developing type 2 diabetes.

Diet Management Support

Acarbose may help individuals adhere to dietary modifications by reducing the rise in blood sugar levels after meals, making it easier to manage carbohydrate intake.

Metabolic Syndrome

Acarbose may also be used in individuals with metabolic syndrome who have elevated blood sugar levels, especially in conjunction with lifestyle modifications such as diet and exercise.

Potential Cardiovascular Benefits

Some studies suggest that acarbose may contribute to the heart health of patients with type 2 diabetes by improving glycemic control, although more research is needed in this area.

Effects on gut microbiota

Research suggests that acarbose may have positive effects on the gut microbiota, which may lead to additional metabolic benefits, although this area is still under investigation.