Use of Acarbose to Control Postprandial Hyperglycemia in Reducing Macrovascular Complication

Manaf, Asman (2010) Use of Acarbose to Control Postprandial Hyperglycemia in Reducing Macrovascular Complication. In: pit xi dep pd fk usu april 2010.

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Abstract

Type 2 diabetes mellitus ( T2DM ) is a progressive disease characterized by declining pancreatic β cell function leading to decreased plasma insulin levels, and insulin resistance. A maladaptive response to insulin resistance may lead to a vicious cycle with more impaired insulin secretion and progression from normal glucose tolerance ( NGT ) to IGT ( prediabetic state ), and T2DM and induces transient endothelial dysfunction. This process is triggered and accelerated by environmental factors such as excess expossure to hyperglycemia (glucotoxicity). Acute postprandial hyperglycemia ( APH ), a rapid increasing of blood glucose level early after meal or food consumption, is considered as a determinant factor of postprandial hyperglycaemia ( PPH ). It is caused by the abnormality of first ( acute ) phase of insulin secretion, the early manifestation of ß cell dysfunction. This important phenomenon, found in either IGT or DMT2, could be the trigger of the progression of disease. Many evidences show that expossure to this metabolic dysregulation substantially increases the risk of developing macrovascular and microvascular complications. Such efforts should be considered in avoiding of increased APH or PPH in order to delay the progression of disease and vascular complications. Lifestyle ( diet and exercise ) and genetic factors ( insulin resistance and impaired insulin secretion ) are believed as contributors or responsible to APH. Then, many studies about treatment on prediabetic person with lifestyle modification, insulin sensitizers ( ie. metformin and glitazone ), insulin secretagogue ( glinides ), or acarbose had been presented. As conclusion, all of above interventions will decrease the incidence of either conversion to T2DM or cardiovascular events. However lifestyle modification will be the most effective strategy. A rapid flux of glucose from the gut will be crucial in developing APH, and alpha glucosidase inhibitors ( ie. acarbose ) have demonstrated its efficacy to prevent it. Administration of acarbose, targeted at APH or PPH, will provide the beneficial effects to improve glucose control, reduce incidence of conversion of IGT to T2DM, and decrease cardiovascular events. So, acarbose is useful in primary and secondary prevention of T2DM . Keywords : postprandial hyperglycaemia, glucose toxicity, diabetes progression and cardiovascular events, acarbose.

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