Primary Drug Names for Alpha-Glucosidase Inhibitors (AGIs)

The primary drug names for Alpha-Glucosidase Inhibitors (AGIs) are acarbose, miglitol, and voglibose. 1, 2

Available AGIs and Their Characteristics

Acarbose is the most widely available AGI globally and is used extensively in clinical practice 1, 2
Miglitol is a second-generation AGI derived from 1-desoxynojirimycin that is almost completely absorbed in the small intestine, unlike acarbose 3, 4
Voglibose is another commercially available AGI, particularly common in Asian countries including China 1, 2

AGIs work by inhibiting carbohydrate absorption in the upper small intestine by inhibiting the α-glucosidase enzymes in the brush border of the intestine 1, 2
This mechanism delays glucose absorption, reduces postprandial blood glucose excursions, and improves overall glycemic control 2, 5
Unlike many other antidiabetic medications, AGIs have a local site of action in the gastrointestinal tract with minimal systemic absorption (particularly acarbose and voglibose) 5, 6

AGIs can lower HbA1c by approximately 0.5-1.0% when used as monotherapy 2, 5
In Chinese patients with newly diagnosed type 2 diabetes, acarbose 300 mg/day demonstrated similar hypoglycemic efficacy to metformin 1500 mg/day 1
The glucose-lowering effect is more pronounced in patients with higher baseline HbA1c values and in those consuming diets high in complex carbohydrates 2, 5
AGIs are particularly effective at reducing postprandial hyperglycemia 2, 7

AGIs do not cause hypoglycemia when used alone, making them suitable for elderly patients or those at risk of hypoglycemia 1, 2
They have a neutral effect on body weight or may cause slight weight loss 6, 4
AGIs have demonstrated cardiovascular safety and may potentially reduce cardiovascular risk factors 8, 6
They can be used in patients with renal insufficiency, unlike some other antidiabetic medications 1

The most common adverse effects are gastrointestinal, including abdominal distension and flatulence 1, 2
Starting with a small dose and gradually increasing can help reduce these adverse effects 2
When patients using AGIs experience hypoglycemia (typically when combined with insulin or insulin secretagogues), glucose or honey should be used as treatments since AGIs impair the digestion of complex carbohydrates 1
AGIs are generally considered third-line agents in Western guidelines due to their modest HbA1c reduction compared to newer agents and their gastrointestinal side effect profile 5, 6

Acarbose is available in tablet form, typically dosed at 50-100 mg three times daily with meals, with a maximum approved daily dose of 300 mg 1
Miglitol is available as 25 mg, 50 mg, and 100 mg tablets, with a maximum approved daily dose of 300 mg 3, 4
Voglibose dosing is typically lower than acarbose, but specific formulations may vary by country 2, 9

Unlike newer agents such as GLP-1 receptor agonists and SGLT2 inhibitors, AGIs have not demonstrated significant cardiovascular outcome benefits in large clinical trials 2
Current guidelines often prioritize SGLT2 inhibitors for patients with heart failure or chronic kidney disease, and GLP-1 receptor agonists for patients with increased cardiovascular risk 1, 2
AGIs may be particularly useful in specific populations, such as elderly patients, those with postprandial hyperglycemia, or when metformin is contraindicated 2, 6