Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-42

Table 8. Alpha-glucosidase inhibitors (13, 24, 38,45,97,101,103,104) Antihyperglycemic agent

Therapeutic Considerations

Mechanism of action • Blocks the alpha-glucosidase enzyme in the brush border of the small intestine that converts carbohydrates into monosaccharides. • Delays the digestion of carbohydrate and the absorption of glucose in the proximal small intestine, thereby lowering postprandial BG levels. Acarbose (Glucobay™) * Use limited by adverse effects • TDD: 25mg -300 mg • Frequency: TID • Taken with first bite of main meal to be effective. Dosing schedule • Initiate with 50 mg QD–TID. • Titrate every 1-2 weeks to 50 mg BID then 50 mg TID. • Titrate every 4-8 weeks to maximum 100 mg TID prn. Benefits • Can be used safely in renal impairment. • ↓ A1C 0.7-0.8%

• Gastrointestinal (GI) side effects common: 30% o Bloating, cramps, diarrhea, abdominal distension o Improves with continued use. • Flatulence most common complaint (80%); occurs as a result of fermentation of unabsorbed carbohydrate, as it sits longer in the large intestine. • Must treat hypoglycemia with pure glucose only, dextrose tablets or can use milk or honey. Rationale: Due to delayed digestion and absorption of sucrose and complex carbohydrates. Meta-analysis: maximum effectiveness at dose of 50 mg TID; higher doses associated with increased adverse events Contraindication • Not recommended if eGFR <30 mL/min/1.73m 2 . • Inflammatory bowel disease, intestinal ulcers, cirrhosis and severe renal impairment • Case reports of reduction in absorption of digoxin and increased absorption of warfarin. Considerations in the elderly ● May require more closer follow-up.

• Targets postprandial BG levels. • Does not cause weight gain or hypoglycemia.