Title:Efficacy and Cardiovascular Safety of Alpha Glucosidase Inhibitors
Volume: 16
Issue: 2
Author(s): Nizam Ud Din Khwaja*Ganesan Arunagirinathan
Affiliation:
- 1Specialty Trainee in Diabetes & Endocrinology, Western General Hospital, Edinburgh,United Kingdom
Keywords:
AGIs (Alpha glucosidase inhibitors), acarbose, CVOT (Cardiovascular Outcome Trial), T2DM (Type 2 Diabetes
Mellitus), postprandial hypoglycemia, miglitol.
Abstract: Alpha Glucosidase Inhibitors (AGIs) are a group of drugs which act on the gastrointestinal
tract and help in reducing fasting and postprandial hyperglycemia by reducing the absorption of
carbohydrates. This group comprises Acarbose, Miglitol and Voglibose. They are available on the
market for almost three decades now. When used as monotherapy, Glycated Haemoglobin (HbA1c)
reduction can be as high as 0.77%, which is predominantly noted in the Eastern Asian population
and those on a high carbohydrate diet. There is a more pronounced reduction in HbA1c in
those who present with higher baseline values. Despite not showing a significant cardiovascular
benefit with regards to mortality and morbidity, they have proven to be a safe class of drugs which
can be used in patients not tolerating various other anti-diabetic agents due to their local site of action
and poor systemic absorption. Though they are available worldwide, AGIs are used more often
in the Far East and South Asia. They have shown benefits in reducing the development of diabetes
when used in those with impaired glucose tolerance or pre-diabetes. They have been shown to improve
postprandial hyperglycemia, which in itself is an independent risk factor for cardiovascular
morbidity. These have proven their safety from both cardiovascular and non-cardiovascular perspectives
and can be combined with any class of anti-diabetic agents. They are not favoured in
most of the current Western Guidelines due to their modest HbA1c reduction, neutrality with cardiovascular
benefit as well as their significant gastrointestinal side effect profile.
