An importance of carbohydrate ingestion for the expression of the effect of alpha-glucosidase inhibitor in NIDDM

OBJECTIVE - To examine the usefulness of alpha-glucosidase inhibitors in glycemic control of patients with NIDDM. The involvement of carbohydrate ingestion in manifestation of the effects of alpha-glucosidase inhibitors was also investigated. RESEARCH DESIGN AND METHODS - A total of 41 patients hospitalized with NIDDM (22 patients receiving sulfonylurea and 19 receiving insulin therapy) were given alpha-glucosidase inhibitors during the period when their blood glucose levels were well controlled. They were followed for 3 weeks as inpatients and for an additional 6 months as outpatients. They were retrospectively divided into two groups according to the percentage of carbohydrates in all sources of calories during outpatient management: the <50% group and the >50% group. Between these two groups, we compared circadian variation in blood glucose levels, HbA(1c), and urine C-peptide. RESULTS - Treatment with alpha-glucosidase inhibitors during the hospital stay markedly improved circadian variation in blood glucose levels and HbA(1c) and decreased urine C-peptide in both groups. While HbA(1c) returned to its pretreatment level at 6 months after the treatment in the <50% group, HbA(1c) had further improved in the > 50% group at 6 months. CONCLUSIONS - alpha-glucosidase inhibitors are useful for glycemic control in patients with NIDDM and the percentage of carbohydrate in all calorie sources is an important factor for the expression of their effects.