Differences Between Acarbose, Voglibose, and Miglitol Explained

Differences Between Acarbose, Voglibose, and Miglitol Explained

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*For reference by medical professionals only

Differences Between Acarbose, Voglibose, and Miglitol Explained

Will You Choose α-Glucosidase Inhibitors?

Look Again

Written by｜Gao Lili

α-Glucosidase inhibitors (AGI) are commonly used clinically, such as Acarbose, Miglitol, and Voglibose. They inhibit the activity of intestinal α-glucosidase, thereby inhibiting carbohydrate breakdown, delaying carbohydrate absorption, reducing glucose production and absorption, lowering postprandial blood glucose (PPG), effectively reducing blood glucose fluctuations, decreasing the risk of diabetes in pre-diabetes (Pre-DM), and reducing the risk of major adverse cardiovascular events (MACE) in patients with Pre-DM and diabetes.

Differences Among Common AGIs
AGIs can be used for patients with elevated PPG due to carbohydrates in food or for diabetic patients whose main energy source is carbohydrate food.

Differences Between Acarbose, Voglibose, and Miglitol Explained

*eGFR: Estimated Glomerular Filtration Rate

Selection of AGI
AGIs can be used to prevent the progression of Pre-DM to diabetes, and can be used alone to treat newly diagnosed T2DM (with efficacy comparable to Metformin, can be a first-line medication), and in combination therapy for T2DM treatment.
① Combination therapy for T2DM
Can be combined with various hypoglycemic drugs such as Metformin and sulfonylureas to control blood sugar.
Combined with Metformin: Metformin can effectively control fasting blood glucose (FPG), while AGI can control PPG, thus the combination can better reduce blood glucose fluctuations and control glycated hemoglobin (HbA1c), and has better weight loss effects.
Combined with sulfonylureas: Can better control PPG and reduce the likelihood of secondary failure of sulfonylureas, without increasing the risk of hypoglycemia.
Combined with SGLT-2 inhibitors: SGLT-2 inhibitors can lower blood sugar, lower blood pressure, reduce uric acid, and promote weight loss, and have clear cardiovascular and renal protective effects. When T2DM is combined with atherosclerotic cardiovascular disease (ASCVD) or cardiovascular risk factors, chronic kidney disease (CKD), heart failure (HF), it is recommended to prioritize combination with SGLT-2 inhibitors.
Combined with DPP-4 inhibitors: AGI can reduce early PPG elevation, while DPP-4 inhibitors can significantly suppress late postprandial blood glucose, and the combination can improve pancreatic β-cell function.
Combined with insulin: Basal insulin can control FPG, but is not effective for PPG control. The combination with AGI can stabilize blood sugar and reduce the risk of hypoglycemia.
② Correcting functional hypoglycemia
Rapid absorption of carbohydrates plays a key role in functional hypoglycemia, and AGI can effectively treat functional hypoglycemia, especially Miglitol, which can be used for reactive hypoglycemia, dumping syndrome, etc.
③ Improving postprandial hypotension
AGI can improve postprandial hypotension symptoms in diabetic patients, and for diabetic patients with postprandial hypotension, the selection of hypoglycemic drugs can be considered.
Selection of AGI in Special Populations
● AGI is contraindicated in patients who may have worsening conditions due to intestinal gas, such as colon ulcers, inflammatory bowel disease, intestinal obstruction, Roemheld syndrome, severe abdominal hernias, etc.;
● AGI is contraindicated in patients with acute diabetic complications such as diabetic ketoacidosis (DKA);
● AGI is contraindicated in patients with chronic gastrointestinal diseases with significant digestive and absorption disorders.
Differences Between Acarbose, Voglibose, and Miglitol Explained
Practice:

Internal medicine outpatient, patient, male, 60 years old.

Diagnosis:① Type 2 diabetes;② Chronic gastrointestinal dysfunction.

Prescription: Acarbose tablets 50mg, 3 times a day, orally.
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Scan the QR code below or click the link at the end to read the original text, open/download the Doctor’s Station APP to learn more content~

Differences Between Acarbose, Voglibose, and Miglitol Explained

References:
[1]. Clinical Application Consensus of α-Glucosidase Inhibitors by Chinese Experts[J]. Chinese Journal of Diabetes, 2024, 32(2):81-90
[2]. Guidelines for Diagnosis and Treatment of Diabetes in Elderly Patients in China (2024 Edition)[J]. Chinese Journal of Diabetes, 2024, 16(2): 147-189
[3]. Guidelines for Rational Use of Medications in Primary Care for Type 2 Diabetes[J]. Chinese Journal of General Practitioners, 2021.20(6):615-630
[4]. Consensus on Assessment and Protection of Pancreatic β-Cell Function in Type 2 Diabetes[J]. Chinese Journal of Diabetes, 2022, 14(6):533-543
[5]. Expert Consensus on Clinical Intervention for Pre-Diabetes in China (Draft for Comments)[J]. Drug Evaluation, 2019, 16(07):3-13
[6]. Expert Consensus on Diagnosis and Treatment of Early-Onset Type 2 Diabetes in Adults[J]. Chinese Journal of Practical Diagnosis and Treatment, 2022, 36(12):1189-1198
[7]. Expert Consensus on Intervention for Pre-Diabetes in Adults in China (2023 Edition)[J]. Chinese Journal of Diabetes, 2023, 15(6):484-494
[8]. Expert Consensus on the Application of SGLT-2 Inhibitors in Elderly Patients with Type 2 Diabetes[J]. Practical Geriatric Medicine, 2023, 37(8):I-V
Editor丨Feng Ziying
* “Medical Community” strives to publish content that is professional and reliable, but does not guarantee the accuracy of the content; relevant parties should verify separately when using or making decisions based on this.
Differences Between Acarbose, Voglibose, and Miglitol Explained
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