Alpha-glucosidase inhibitor

Source: Wikipedia, the free encyclopedia.

Alpha-glucosidase inhibitors (AGIs) are oral

blood sugar
.

Examples and differences

Examples of alpha-glucosidase inhibitors include:

Even though the drugs have a similar mechanism of action, there are subtle differences between acarbose and miglitol. Acarbose is an oligosaccharide, whereas miglitol resembles a monosaccharide. Miglitol is fairly well absorbed by the body, as opposed to acarbose. Moreover, acarbose inhibits pancreatic alpha-amylase in addition to alpha-glucosidase, and is degraded by gut bacterial maltogenic alpha-amylase and cyclomaltodextrinase.[1][2]

Natural alpha glucosidase inhibitors

There are a large number of natural products with alpha-glucosidase inhibitor action.[3][4]

For example, research has shown the culinary mushroom

hypoglycemic effect.[5][6][7][8][9][10] The reason Maitake lowers blood sugar is because the mushroom naturally contains an alpha glucosidase inhibitor.[11] Another plant attracting a lot of attention is Salacia oblonga.[12]

Clinical use

diabetic diet
and exercise, or they may be used in conjunction with other anti-diabetic drugs.

A Cochrane systematic review assessed the effect of AGIs in people with impaired glucose tolerance, impaired fasting blood glucose, elevated glycated hemoglobin A1c (HbA1c).[13] It was found that Acarbose appeared to reduce incidence of diabetes mellitus type 2 when compared to placebo, however there was no conclusive evidence that acarbose compare to diet and exercise, metformin, placebo, no intervention improved all-cause mortality, reducer or increased risk of cardiovascular mortality, serious or non-serious adverse events, non-fatal stroke, congestive heart failure, or non-fatal myocardial infarction.[13] The same review found that there was no conclusive evidence that voglibose compared to diet and exercise or placebo reduced incidence of diabetes mellitus type 2, or any of the other measured outcomes.[13]

In patients with

diabetes mellitus type 1, alpha-glucosidase inhibitors use has not been officially approved by the Food and Drug Administration in the US but some data exists on the effectiveness in this population, showing potential benefits weighted against an increased risk of hypoglycemia.[14]

Mechanism of action

Alpha-glucosidase inhibitors are

alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose
and other monosaccharides in the small intestine.

Acarbose also blocks pancreatic alpha-amylase in addition to inhibiting membrane-bound alpha-glucosidases.

oligosaccharides
in the lumen of the small intestine.

Inhibition of these enzyme systems reduces the rate of digestion of carbohydrates. Less glucose is absorbed because the carbohydrates are not broken down into glucose molecules. In

hemoglobin A1c level.[15]

Dosing

Since alpha-glucosidase inhibitors are competitive inhibitors of digestive enzymes, they must be taken at the start of main meals to have maximal effect. Their effects on blood sugar levels following meals will depend on the amount of complex carbohydrates in the meal.

Side effects and precautions

Since alpha-glucosidase inhibitors prevent the degradation of complex carbohydrates into glucose, the carbohydrates will remain in the intestine. In the

colon, bacteria will digest the complex carbohydrates, thereby causing gastrointestinal side effects such as flatulence and diarrhea
. Since these effects are dose-related, it is generally advised to start with a low dose and gradually increase the dose to the desired amount.
Pneumatosis cystoides intestinalis is another reported side effect.[16] If a patient using an alpha-glucosidase inhibitor suffers from an episode of hypoglycemia, the patient should eat something containing monosaccharides, such as glucose tablets. Since the drug will prevent the digestion of polysaccharides (or non-monosaccharides), non-monosaccharide foods may not effectively reverse a hypoglycemic episode in a patient taking an alpha-glucosidase inhibitor.[citation needed
]

See also

References

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  2. PMID 10103262
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  3. PMID 20522017
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  4. PMID 20815224
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  5. S2CID 34210764
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  6. S2CID 85987141
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  7. PMID 7820117
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  8. PMID 18457360
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  9. S2CID 23788507
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  10. PMID 11349892
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  11. PMID 12224646
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  12. ^ Vyas N, Mehra R, Makhija R. Salacia - The new multi-targeted approach in diabetics. Ayu. 2016;37(2):92-97. doi:10.4103/ayu.AYU_134_13
  13. ^
    PMID 30592787
    .
  14. ^ Alternative Agents in Type 1 Diabetes in Addition to Insulin Therapy: Metformin, Alpha-Glucosidase Inhibitors, Pioglitazone, GLP-1 Agonists, DPP-IV Inhibitors, and SGLT-2 Inhibitors. Michelle DeGeeter, PharmD, CDE, Bobbie Williamson, PharmD, BCACP, CDE. Journal of Pharmacy Practice Vol 29, Issue 2, pp. 144 - 159. First Published October 13, 2014 https://doi.org/10.1177/0897190014549837
  15. ISBN 0-7817-4839-9.[page needed
    ]
  16. PMC 9571713
    . Retrieved 2024-05-01.
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