Effects of voglibose on glycemic excursions, insulin secretion, and insulin sensitivity in non-insulin-treated NIDDM patients

OBJECTIVE - To investigate the effects of voglibose, an alpha-glucosidase inhibitor, on daily glycemic excursions, insulin secretion, and insulin sensitivity in non-insulin-treated NIDDM patients. RESEARCH DESIGN IND METHODS - An open prospective study uas conducted in 27 NIDDM patients receiving diet therapy alone or treatment with a sulfonylurea drug, Of the study subjects, 14 patients were treated with voglibose; the remaining 13 patients served as the control group. The metabolic parameters were evaluated before treatment and at week : of treatment as follows: glycemic excursions by M-value and 1,5-anhydro-D-glucitol (1,5-AG), insulin secretion by area under the curve of daily serum insulin (AUC(insulin)), and insulin sensitivity by the K index of the insulin tolerance test (K-ITT) RESULTS - After the study treatment. HbA(1c) and plasma glucose in the patients who had received voglibose were comparable to those of patients in the control group. M-value was lower in the patients treated with voglibose than in the control subjects (5.7 +/- 0.9 vs. 9.8 +/- 1.2, P < 0.05). 1,5-AG was higher in the patients treated with voglibose than in the control subjects (12.2 +/- 1.0 vs. 8.2 +/- 0.7 mu g/ml, P < 0.01). A statistically significant decrease in AUC(insulin) occurred after treatment with voglibose (2,223.5 +/- 390.6 to 1,546.7 +/- 303.4 pmol . l(-1). h, P < 0.05), but no change occurred in the control group (2,364.5 +/- 315.4 to 2,464.2 +/- 269.3 pmol . l(-1). h, P = 0.60). Insulin sensitivity (K-ITT) was improved to a statistically significant level in both the patients treated with voglibose and the patients in the control group. K-ITT in the patients after voglibose treatment was comparable to that of the control group (3.18 +/- 0.30 vs, 3.21 +/- 0.23%/min. P = 0.94). CONCLUSIONS - The results suggest that voglibose lowers the daily glycemic excursions and inhibits overwork of the pancreatic beta-cells but has little effect on insulin sensitivity in NIDDM patients.