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- Medications for type 2 diabetes
- Meglitinides (Prandin and Starlix)
- Metformin (Glucophage)
- Canagliflozin (Invokana) and dapagliflozin (Farxiga)
- Thiazolidinediones: pioglitazone (Actos) and rosiglitazone (Avandia)
- Acarbose (Precose)
- Pramlintide (Symlin)
- Exenatide (Byetta)
- Liraglutide (Victoza)
- Long-acting exenatide (Bydureon)
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
- DPP-IV inhibitors (sitagliptin, saxagliptin, linagliptin)
- Combination medications
- Treatment of diabetes with insulin
- Different methods of delivering insulin
- Diabetes diet
- The future of pancreas transplantation
Acarbose (Precose) is a medication that decreases the absorption of carbohydrates from the intestine. Before being absorbed into the bloodstream, enzymes in the small intestine must break down carbohydrates into smaller sugar particles, such as glucose. 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.
The name of the alpha-glucosidase inhibitor available in the U.S. is acarbose (Precose). Placebo-controlled clinical trials with over 700 patients associated acarbose with reduction of hemoglobin A1c (HbA1c) values. HbA1c is the standard clinical measure of average blood sugars over the preceding three months. However, as a single agent, acarbose has not been as effective as other antidiabetic medications. Since acarbose works in the intestine, its effects are additive to antidiabetic medications that work at other sites (such as sulfonylureas). Clinical studies have demonstrated statistically better control of blood glucose in patients treated with acarbose and a sulfonylurea, compared to the sulfonylurea alone. Acarbose is currently used alone or in combination with a sulfonylurea.
- Acarbose is taken three times a day at the beginning of meals. The dosage varies from 25 to 100 mg before each meal. The maximum recommended dose is 100 mg three times a day.
Acarbose side effects and warnings: Because of its mechanism of action, acarbose has significant gastrointestinal side effects (the most common symptoms seen in up to 75% of patients taking acarbose) such as:
For this reason, acarbose is administered using a low initial dose, and then increased over weeks depending on how well the patient tolerates the medication. Most gastrointestinal symptoms tend to subside over the course of a few weeks, although some patients report persistent problems.
At greater doses, reversible abnormalities in liver tests may be seen.