How Do Antidiabetic Alpha-Glucosidase Inhibitors Work?

Alpha-glucosidase inhibitors (AGIs) are oral antidiabetic drugs used to control high blood sugar in people with type 2 diabetes mellitus (T2DM), particularly in those whose diabetes cannot be controlled by diet alone. T2DM is a condition in which the body does not use insulin normally and therefore cannot control the amount of sugar in the blood. Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage (numb, cold legs, or feet; decreased sexual ability in men and women), and eye problems. Medications along with lifestyle changes (diet, exercise, and quitting smoking) and regular checking of blood sugar may help to manage diabetes, improve health, and prevent a heart attack, stroke, or other diabetes-related complications.

AGI inhibits the breakdown of complex carbohydrates into glucose. They are used in T2DM for establishing greater glycemic control by preventing the digestion of carbohydrates (such as disaccharides, oligosaccharides, and polysaccharides) into monosaccharides which can be absorbed by the body easily.

AGIs are prescription-only medicines and are administered via oral route. They are typically taken three times a day.

AGIs work in the following ways:

• They decrease the absorption of carbohydrates (starch and sugar) from the intestine, resulting in a slow and lower rise in blood glucose throughout the day, particularly immediately after meals. 
• Carbohydrates are normally converted into simple sugars (monosaccharides) by alpha-glucosidase enzymes (involved in the breaking down of carbohydrates) present on cells lining the intestine, enabling monosaccharides to be absorbed through the intestine.
• They are man-made oligosaccharides designed to slow down the actions of alpha-amylase (a pancreatic enzyme) and alpha-glucosidase enzymes, thereby slowing the appearance of sugar in the blood after a meal (postprandial hyperglycemia).

AGIs are used together with diet and exercise to treat T2DM either as monotherapy or along with sulfonylurea (drugs that work by increasing the release of insulin from the pancreas).

Some of the common side effects include:

• Diarrhea
• Abdominal pain
• Flatulence (gas)
• Breath that smells fruity
• Headache

Other rare side effects include:

• Elevated serum transaminase level (a liver enzyme)
• Thrombocytopenia (low blood platelet count)
• Dizziness (feeling faint, weak, or unsteady)
• Confusion
• Pneumatosis cystoides intestinalis (a condition characterized by gas-filled cysts in the intestinal submucosa and subserosa)
• Symptoms of hypoglycemia (low blood sugar)
  • Confusion
  • Sudden sweating
  • Fast heartbeat
  • Loss of consciousness
• Symptoms of hyperglycemia (high blood sugar):
  • Extreme thirst
  • Frequent urination
  • Extreme hunger
  • Weakness
  • Blurred vision

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of antidiabetic glucosidase inhibitors include:

• Acarbose
• Glyset
• Miglitol
• Precose