1. Carbohydrate absorption inhibitors α-glucosidose inhibitors
Acarbose:
Dose
Adverse events

3. Determinants of PPG Relatively complex network controlling PPG:
Pre-prandial glycaemic level
Insulin secretion and insulin sensitivity
Glucagon and other counter-regulatory hormones
PPG
Meal size and meal content
Gastric emptying and incretin hormones
FPG, fasting plasma glucose; PPG, postprandial plasma glucose
1. Ceriello. Int J Clin Pract 2010;64:1705–11; 2. Alsahli & Gerich. Ref Mod Biomed Res 2014;doi: /B

4. Prandial insulin secretion
Cephalic phase of insulin secretion1
Evoked by the sight, smell and taste of food (before gut absorption)
Postprandial biphasic insulin secretion2:
First phase/early phase, transitory:
Critical role in PPG homeostasis (targeting the liver)
Can prevent chronic postprandial hyperglycaemia (glucotoxicity) and chronic hyperinsulinaemia (beta-cell exhaustion)
Second phase, more gradually:
Related to the degree and duration of the stimulus
β-cell insulin content3:
2–3% released during first phase
20% released during second phase
First- and second-phase insulin secretion in the β-cell4
240
Insulin secretion
Time (min) 5
Second-phase insulin secretion
Glucose stimulation
First-phase insulin secretion
PPG, postprandial plasma glucose
Bruce et al. Metabolism 1987;36:721–5; 1. Caumo & Luzi. Am J Physiol Endocrinol Metab 2004;287:E371–85; 2. DelPrato. Diabetologia 2003;46(Suppl. 1):2–8; 3. Cheng et al. Curr Molec Med 2013;13:126–39

17. Acarbose
300 mg Acarbose = 1500 mg Metformin

18. Acarbose Initially 25 mg po with first bite of meals.
Can increase mg q8h at 4-8 w, base on:
PPG – HbA1C- tolerance.

19. Prandial insulin secretion
240
Insulin secretion
Time (min) 5
Second-phase insulin secretion
Glucose stimulation
First-phase insulin secretion

20. Maximum Dose:
< 60 kg 50 mg q8h
> 60 kg 100 mg q8h

21. Efficacy and safety of combination therapy with an alpha-glucosidase inhibitor and a dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes mellitus: A systematic review with meta-analysis
AGI increases GLP-1 secretion. Because DPP4 inhibitor protects GLP-1 and GIP from enzymatic degradation, combination of DPP4 inhibitor and AGI may synergistically increase active GLP-1 levels.

22. In conclusion, addition of a DPP4 inhibitor to patients with inadequately controlled T2DM with AGI therapy achieved a clinically significant improvement in glycemic control without increasing the risk of weight gain and hypoglycemia. Therefore, this combination should be a viable option in the pharmacological therapy for T2DM.