From the Guidelines
Acarbose is a recommended treatment for dumping syndrome and type 2 diabetes, with a typical starting dose of 25 mg taken with the first bite of each main meal, which can be gradually increased to 50-100 mg three times daily as tolerated 1. The medication works by inhibiting alpha-glucosidase enzymes in the small intestine, preventing the breakdown of complex carbohydrates into glucose and delaying glucose absorption. This mechanism reduces post-meal blood sugar spikes without causing hypoglycemia when used alone. Some key points to consider when using acarbose include:
- Starting with a low dose and gradually increasing it helps minimize gastrointestinal side effects like flatulence, bloating, and diarrhea 1
- Acarbose is particularly useful for patients who experience high blood sugar after meals despite other treatments 1
- It should be taken consistently with meals to be effective, and patients should be aware that hypoglycemia must be treated with glucose (not table sugar or complex carbohydrates) since acarbose will inhibit their digestion 1
- The maximum daily dose should not exceed 150-300 mg depending on patient weight 1
- Acarbose can be used in combination with biguanides, sulfonylureas, TZDs, or insulin 1
- Clinical studies have shown that acarbose 300 mg/day demonstrated a similar hypoglycaemic effect to that of metformin 1500 mg/day in newly diagnosed patients with diabetes 1
From the FDA Drug Label
Acarbose is a complex oligosaccharide that delays the digestion of ingested carbohydrates, thereby resulting in a smaller rise in blood glucose concentration following meals. The antihyperglycemic action of acarbose results from a competitive, reversible inhibition of pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolase enzymes Acarbose tablets, USP are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The main use of Acarbose is to improve glycemic control in adults with type 2 diabetes mellitus by delaying carbohydrate digestion and reducing postprandial hyperglycemia 2.
- Key benefits:
- Delays carbohydrate digestion
- Reduces postprandial hyperglycemia
- Improves glycemic control in type 2 diabetes mellitus
- Mechanism of action: Competitive, reversible inhibition of pancreatic alpha-amylase and intestinal alpha-glucosidase enzymes 2.
From the Research
Acarbose Mechanism and Efficacy
- Acarbose reduces postprandial plasma glucose excursions by delaying the absorption of carbohydrate from the small intestine 3.
- It is an effective first-line therapy for patients with newly diagnosed type 2 diabetes and induces a further improvement in glycemic control when used in combination with other antidiabetes agents 3.
- Acarbose therapy decreases fasting and postprandial serum insulin, fasting plasma glucose, and hemoglobin A1c levels by decreasing postprandial hyperglycemia and improving insulin sensitivity 3, 4.
Acarbose Safety and Tolerability
- Acarbose has a sustained efficacy, tolerability, and excellent safety profile in a wide range of patient types 3.
- The most common adverse events associated with acarbose are gastrointestinal, including abdominal pain, flatulence, and diarrhea, which are more frequent than in placebo patients but attenuate over time 5.
- Acarbose is safe and well tolerated by the majority of diabetic patients over a 1-year treatment period 5.
Acarbose in Combination with Other Therapies
- Acarbose can be used as first-line therapy with diet and exercise, or in combination with sulfonylureas to lower hemoglobin A1c concentrations 4.
- The enhanced glycemic control achieved with acarbose is additive to that of sulfonylureas 4.
- Acarbose does not stimulate endogenous insulin secretion and will not cause hypoglycemia when used as monotherapy 4.