Diabetes Treatment (cont.)
Medications that decrease the absorption of carbohydrates from the intestine
Before being absorbed into the bloodstream, carbohydrates must be broken down
into smaller sugar particles, such as glucose, by enzymes in the small
intestine. One of the enzymes involved in breaking down carbohydrates is called
alpha glucosidase. By inhibiting this enzyme, carbohydrates are not broken down
as efficiently and glucose absorption is delayed.
Precose
The name of the alpha glucosidase inhibitor available in the U.S. is acarbose
(Precose). In clinical trials with over 700 patients, the use of Precose was
associated with a reduction in hemoglobin A1c values (a well known measurement
of average blood sugars over the preceding three months) that was significantly
greater than the use of placebo (no treatment). However, as a single agent,
Precose is not as effective as the other medications for diabetes. Since Precose
works in the intestine, its effects are additive to diabetic medications that
work at other sites, such as sulfonylureas. Clinical studies have shown
statistically better control of blood glucose in patients treated with Precose
and a sulfonylurea compared to the sulfonylurea alone. Precose is currently used
alone or in combination with a sulfonylurea.
Precose is taken three times a day at the beginning of meals. The dosage
varies from 25 to 100mg with each meal. The maximum recommended dose is 100mg
three times a day. At doses greater than this, reversible abnormalities in liver
tests may be seen. Because of its mechanism of action, Precose has significant
gastrointestinal side effects. Abdominal pain, diarrhea, and
gas are common and
are seen in up to 75% of patients taking Precose. For this reason, Precose is
administered using a low initial dose that is increased over weeks depending on
the patient's tolerance. Most of the gastrointestinal symptoms tend to subside
over the course of a few weeks although some patients report persistent
problems.
Next: New medications that affect glycemic control (Symlin and Byetta) »
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