Effect of acarbose on blood glucose profiles and plasma 1,5-anhydro-D-glucitol in type 2 diabetes poorly controlled by sulfonylurea therapy

Sixteen patients with type 2 diabetes poorly controlled by glibenclamide (7.5–10.0 mg/day) were treated with acarbose (100 mg tds) for one week and the effect on the blood glucose profile, 24-hour urinary glucose excretion, plasma fructosamine, and plasma 1,5-anhydro-D-glucitol (1,5-AG) level was determined. The blood glucose profile was more stable and levels were lower during acarbose administration. In some patients, this improvement was maintained after discontinuing acarbose. The M-value, an indicator of blood glucose fluctuations, decreased significantly from 33.2 ± 3.0 (mean ± SEM) in the run-in period to 13.4 ± 2.4 during acarbose therapy (P< 0.001), and rose again to 26.5 ± 4.4 (P< 0.001) in the follow-up period. The 24-hour urinary glucose excretion and plasma fructosamine decreased similarly (P< 0.001 and P< 0.01, respectively) during and after acarbose therapy. Plasma 1,5-AG levels did not change significantly during acarbose therapy, but increased markedly afterwards (from 19.3 ± 3.1 μmol 1−1 to 25.0 ± 3.1 μmol 1−1, P< 0.001). Plasma 1,5-AG levels were significantly correlated with urinary glucose excretion one week earlier (r = 0.513, P< 0.006). These findings suggest that acarbose may improve glycemic control in type 2 diabetic patients poorly controlled by sulfonylurea therapy and that plasma 1,5-AG might be used as a marker of glycemic control cooperating with other markers such as fructosamine and urinary glucose determination for monitoring the short-term response to antidiabetic therapy.