Thursday, November 17, 2011

Acarbose , treating hypoglycemia ? Acarbose , cardioprotective effect ?

Answer to yesterdays question .

For People Who Take Acarbose (Precose) or Miglitol (Glyset)

People who take either of these diabetes medications should know that only pure glucose, also called dextrose-available in tablet or gel form-will raise their blood glucose level during a low blood glucose episode. Other quick-fix foods and drinks won't raise the level quickly enough because acarbose and miglitol slow the digestion of other forms of carbohydrate

These two drugs Precose and Glyset inhibit intestinal and pancreatic enzymes that convert carbohydrates into glucose.These medications have not been popular because of side effects , flatulence, diarrhea and abdominal pain.

Acarbose is used to reduce after meal glucose increases and may help lower the risk of heart disease . I have attached comments from the 2011 American Heart Association scientific sessions below. The discussion was about the cardioprotective effect of diabetes medications .

Acarbose re-examined

The older, already FDA-approved drug acarbose may also be a viable option, as it could potentially target postprandial glycemia as a risk factor for CVD, Rury R. Holman, FRCP, of the Oxford Centre for Diabetes, Endocrinology & Metabolism in the United Kingdom, said.

Several trials have associated acarbose with reductions in postprandial glucose and subsequent decreases in CVD risk factors. The Study to Prevent Noninsulin-Dependent Diabetes Mellitus (STOP-NIDDM), for example, revealed a 49% RR reduction for development of CV events in patients with impaired glucose tolerance in a secondary analysis. Similarly, data from a study in Japan linked acarbose with improved postprandial flow-mediated dilation and, thus, improved endothelial function.

To further investigate this association, Holman and colleagues are conducting the Acarbose Cardiovascular Evaluation (ACE) study - a multicenter, double blind, randomized controlled trial designed to assess potential CV benefits of acarbose in 7,500 patients with preexisting CVD and IGT. The study will be at 50% recruitment by the end of 2011 and results are expected in 2017, he said.

"When acarbose first came to the market in the late 1990s, it was seen as a head-to-head HbA1c-lowering drug," Holman said. "If its only impact is on postprandial glucose, it can only ever modestly reduce HbA1c. The drug is really meant to be given in combination, so if it was to be a CV-protecting drug, maybe there is some way to easily roll it out in other doses

Diabetes care is about winning in a game of numbers . Play hard. Dr . Calder

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Your comments and questions are appreciated. David Calder,MD