Alpha Glucosidase Inhibitors: Benefits, Risks, and Contraindications

Given that diabetes is a complicated condition, it’s not surprising that it also calls for various medications. Two of the most common drugs that control diabetes are metformin and insulin. But have you heard about alpha glucosidase inhibitors? You see, it turns out that this drug can also significantly manage a person’s blood sugar levels. 

First, What is Alpha Glucosidase?

Alpha glucosidase is an enzyme that processes glucose (simple sugars) from starch (complex sugars). That means when we eat foods, particularly those rich in carbohydrates, alpha glucosidase helps break them down into simple glucose, which is then absorbed by the intestine, thereby increasing blood glucose. 

What Do Alpha Glucosidase Inhibitors (AGI) Do?

Now, alpha glucosidase inhibitors (AGIs) retard or hinder the function of alpha glucosidase. Hence, these drugs can delay glucose absorption in the intestine and reduce postprandial plasma glucose or the blood sugar level after meals. 

Doctors prescribe AGIs to people with Type 2 diabetes. People with impaired glucose tolerance (prediabetes) may also benefit from them as they have been shown to delay the development of Type 2 DM. 

Reports say AGIs are particularly helpful in patients with a higher risk of hypoglycemia or lactic acidosis, as common medicines, like metformin, are not suitable for them. 

The Benefits of Alpha Glucosidase Inhibitors

Theoretically, it’s easy to see how AGIs help manage blood glucose. But, what do studies say about them?

In a report published in the American Diabetes Association, experts reviewed 41 studies involving monotherapy with alpha glucosidase inhibitors. They checked the medicine’s effect in glycemic control, insulin levels, plasma lipids (fats), weight, side effects, morbidity and even mortality. 

They discovered that while AGIs do not have an effect on the patient’s plasma lipids, morbidity and mortality, they do have beneficial effects on HbA1c levels, postprandial and fasting blood sugar, and postload insulin. Higher doses of AGIs don’t seem to increase the benefits, but they appear to increase the side effects. A type of AGIs called Acarbose also seem to help decrease the body mass index of some patients4. 

How Do You Take AGIs?

Patients take AGIs orally, usually three times a day. They either chew the pill with the first bite of the meal or swallow it whole with water immediately before eating. 

As with many medications, doctors usually initially prescribe the lowest dose possible before making adjustments to achieve the best glucose control. Starting with a lower dose also helps reduce the side effects. 

Finally, monotherapy with AGIs is common, but it’s also possible for patients to take other drugs, like sulphonylurea. 

What are the Side Effects of AGIs?

Since alpha glucosidase inhibitors limit the absorption of glucose in the intestines, the most common side effects center on gastrointestinal symptoms. 

Among all gastrointestinal effects, flatulence (wind) is the most common, appearing in 78% of cases. Still, diarrhea and abdominal pain may also happen. 

The good news is that the side effects typically get better as your body gets used to the medication. 

Who Shouldn’t Take Alpha Glucosidase Inhibitors?

People who have gastrointestinal issues are not advised to take AGIs. Examples include inflammatory bowel disease and colonic ulceration. 

It’s also contraindicated to people who have intestinal obstruction or are at a high risk of developing intestinal obstruction. People whose condition can worsen due to excessive gas should also not take alpha glucosidase. 

Of course, contraindications also include having hypersensitivity to this drug. 

Key Takeaways

AGIs hamper alpha glucosidase, an enzyme needed to process complex sugars into simple glucose. As a result, the medicine helps delay glucose absorption in the intestine, which then reduces blood glucose. AGIs are typically prescribed to type 2 DM patients and those with prediabetes. 

Learn more about Type 2 Diabetes here.