Alpha-glucosidase inhibitors delay glucose absorption and lower post-prandial glucose levels by inhibiting enzymes needed to digest carbohydrates. Glucobay® is the only medication from this class available in Canada.
1. Therapeutic Considerations
All information from medication product monograph unless referenced below.
| A1c Lowering | 0.5-1.0%1 |
| Hypoglycemia Risk | Low; *Treat with glucose (dextrose) tablets as sucrose absorption is inhibited by this medication. |
| Class Side Effects | Gastrointestinal (GI) side effects including flatulence, bloating and/or diarrhea. Diets high in sucrose (cane sugar) can contribute to greater GI intolerance. |
| Vascular Protection | No |
| Renal Protection | No |
| Heart Failure Hospitalization Benefit | No |
| Weight | Neutral |
| Cost, Blue Cross coverage; strengths; dosing frequency; indications | |
| Combination Medications | None |
| Advice for times of dehydration, vomiting, diarrhea | Diabetes Canada advises this medication be taken as directed unless otherwise directed by a healthcare provider. |
| Other |
Tablet to be taken with first bite of food. |
2. Dosing Considerations
- The daily dose of acarbose may be adjusted based on 2 hour post prandial glucose levels and/or A1c level.
- Usual starting dose is 50 mg once daily. After 1-2 weeks dosage increased to 50 mg twice daily, then increased to 50 mg three times daily after further 1-2 weeks.
- Starting with a low dose and titrating up slowly may help reduce potential GI side effects.
- Not advised for eGFR < 30. Refer to Renal Impairment Considerations, Diabetes Canada.
References:
1. Inzucchi SE, Bergenstal RM, Buse JB, det al. Management of hyperglycemia in type 2 diabetes: a patient-centred approach. Diabetes Care 2012; 35: 1364-79. http://care.diabetesjournals.org/content/35/6/1364 (Accessed Feb 26, 2018).