- Alpha-glucosidase inhibitors work by preventing the digestion of carbohydrates like starch and sugar. They do this by competitively inhibiting the enzymes needed to break down carbs into simpler sugars that can then be absorbed. - This delays the absorption of carbohydrates and lowers post-meal blood glucose levels over the long-term. Current guidelines support their use alone or along with other drugs for poorly controlled type 2 diabetes. - Common side effects include gas and stomach discomfort due to undigested carbs passing into the colon. Efficacy is modest but they provide glycemic control without weight gain or hypoglycemia risks seen with other drugs.

1. Voglibose
Alpha-glucosidase Inhibition

2. Alpha-glucosidase Inhibitors

3. Alpha-glucosidase Inhibitors

4. Alpha-glucosidase Inhibitors
 α-Glucosidase inhibitors (AGI) are anti-
hyperglycemic agents that, by blockade of
oligosaccharide catabolism,
1. Delay (in small doses) or
2. inhibit (in larger doses) carbohydrate digestion and
absorption,
 and, thus inhibit/ maintain smooth and lower blood
glucose levels after a meal.
 Current consensus supports their use as
monotherapy or adjunct therapy for poorly
controlled NIDDM.

5. Alpha-glucosidase Inhibitors
 Acarbose
 Miglitol Acarbose
 Voglibose Miglitol
Voglibose

6. Alpha-glucosidase Inhibitors
 Work by preventing the digestion of carbohydrates
 Starch, table sugar
 Carbohydrates normally digest to create simple
saccharides
 Absorbed in the intestines (small)
 Mechanism of action includes competitive inhibition
of enzymes needed to digest carbohydrates
 Reduces rate of digestion of carbohydrates!
 Long-term effects include a small decrease in
hemoglobinA1c levels

7. 7
Alpha-glucosidase Inhibitors
 Efficacy
the enzyme α-glucosidase in the gut
 Inhibit
 Prevent conversion of complex CHO to simple CHO
 Thus, delay the absorption of CHO
 Hence, reduced PPBG excursions
 Very modest in efficacy, usually take 6-8 weeks
 Side Effects
 Flatulence or abdominal discomfort common
 No effect on lipids or blood pressure
 No weight gain or loss
 Contraindicated in IBD or Cirrhosis

8. Alpha-glucosidase Inhibitors
Acarbose Miglitol & Voglibose
  postprandial hyperglycemia   postprandial hyperglycemia
 Inhibits glycoside hydrolases  Inhibit glycoside hydrolases
 glucosidase  Taken at beginning of a meal
 Taken at beginning of a meal  Miglitol is systemically
 Gastrointestinal side effects absorbed
 Common  Excreted by the kidneys
 Higher efficacy than Voglibose  Voglibose is newest:
 less side effects
 economical
Miglitol Voglibose
Acarbose

9. Alpha-glucosidase Inhibitors

10. Alpha-glucosidase Inhibitors

11. Alpha-glucosidase Inhibitors
 Indications
 Newly diagnosed patients insufficiently treated
with diet and dominating postprandial
hyperglycemia
 Elderly multimorbid patients
 Elderly patients with weight gain or hypoglycemia
under treatment with insulin secretagogues
 Patients with hepatic or renal disorders

12. Advice to patients on AGIs
 Start low, go slow
 Prefer nutrients with complex carbohydrates (rice,
pasta, full
 bread, vegetables, fruits)
 Avoid refined carbohydrates (sugar, sweets).
 Take only three meals
 Avoid laxatives, such as sugar alcohols (sorbitol)
 Control your postprandial blood glucose to
experience the efficacy of treatment
 In most cases gastrointestinal side-effects are
transient

13. Alpha-glucosidase Inhibitors
 AGIs have clear beneficial effects on
glycemic control and postload insulin levels
but not on plasma lipids.
 In patients with type 2 diabetes, alpha
glucosidase inhibitors improve glycaemic
control in studies of mainly 24 weeks’
duration.
 Data are lacking on the effects of alpha
glucosidase inhibitors on mortality, diabetes
related morbidity, and quality of life.

14. Therapy algorithm