Effect of a long-term acarbose therapy on the metabolic control of sulphonylurea-treated diabetic patients
I would like to add some cautionary comments regarding the
confusion over the extent of insulin degradation at the subcutane-
ous injection site in experimental animals and man reported in this
journal  and elsewhere.
Evidence for considerable subcutaneous insulin degradation
has been provided in rat [2
Effect of a Long-Term Acarbose Therapy on the Metabolic Control o f Sulphonylurea-Treated Diabetic Patients
0 G. Sachse III. Medizinische Universit~itsklinik und Poliklinik Rodthohl 6 D-6300 Giessen, FRG
1 Yours sincerely G. Sachse, H. Laube, E. M~iser and K. Federlin
a homogenate of the adipose tissue of a patient with severe resistance to subcutaneously administered insulin. However, confusion has arisen over whether the protease inhibitor aprotinin (Trasylol) can protect against insulin degradation at the subcutaneous site. It has been reported that aprotinin increases the rate and absolute amount of insulin absorption from the subcutaneous tissue of non-diabetics  and reduces the subcutaneous insulin requirements in some insulin-resistant diabetics [9, 1l, 12], while others have been unable to confirm these findings in a Type 1 (insulin-dependent) diabetic patient  or in Type 2 (non-insulin dependent) diabetic subjects . However, the latter group did not report glycaemic changes and concluded that aprotinin had no el-
The blood glucose lowering effect of acarbose, an
alpha-glucosidase inhibitor, has been adequately documented by short term
studies [1~,]. However, a lack of effectiveness with longer term
administration of acarbose in patients with Type 2
(non-insulin-dependent) diabetes has been reported [
In contrast to these findings, we would like to report our own
results. After a 3-month prior period on sulphonylureas alone, 24
sulphonylurea-treated Type 2 diabetics (aged 53-79 years,
Broca-index > 1,1, mean post-prandial blood glucose > 11 mmol/1, urinary
glucose > 5 g/24 h) received in addition acarbose 300 mg/day or
placebo for 6 months. Afterwards, all patients continued with
sulphonylureas alone for a further 3 months.
During administration of acarbose, we saw a significant
lowering of the post-prandial blood glucose values (10.9 _+2.4 compared
with 16.0_+3.6 mmol/1, mean + SD, p <0.00I), of mean daily
blood glucose levels (8.6_+1.7 compared with 12.3 -+2.8 retool/l;
p < 0.001), of 24 h urinary glucose excretion (2 _+0.4 compared with
13 + 6 g/24 h; p < 0.005) and HbA~a< values (9.1 + 0.4 compared
with 12.4 + 0.6%; p < 0.005).
Other laboratory determinations (fasting blood glucose, serum
insulin, blood lipids, electrolytes, liver and kidney function) did not
show any significant alterations during the entire study period.
There was no change in body weight.
When acarbose was discontinued, the parameters specified
above rose significantly again within 4 weeks (post-prandial blood
glucose values: 14.9+3.2 mmol/l; mean daily blood glucose
levels: 12.7+2.3 mmol/1; 24 h urinary glucose excretion:
12 _+5 g/24 h and HbAla-c values: 13.1 _+0.4%).
In the placebo group, there was no significant alteration of the
metabolic state during the entire 12 months. Side effects (flatulence
and meteorism) subsided after about 4 weeks and did not recur
again during the rest of the experimental period.
Our results show that additional administration of acarbose to
sulphonylurea-treated diabetics leads to a persistent improvement
of metabolic control over a long period.
1. Walton RJ , SherifJT, Noy GA , Alberti KGMM ( t979 ) Improved metabolic profiles in insulin-treated diabetic patients given an alpha-glucoside hydrolase inhibitor . Br Med J 1 : 220 - 221
2. Laube H , Fouladfar M , Aubelt R , Schmitz H ( 1980 ) Zur Wirkung des Glukosidasehemmers Bay g 5421 (Acarbose) auf das Btutzuckerverhalten bei adip6sen Erwachsenendiabetikern . Arzneim Forsch 30 : 1154 - 1157
3. Sachse G , Willms B ( 1979 ) Effect of the alpha-glucosidase inhibitor Bay g 5421 on blood glucose control of sulphonylureatreated diabetics and insulin-treated diabetics . Diabetologia 17 : 287 - 290
4. Vierhapper H , Bratusch-Marrain P , Waldh~iusl W ( 1978 ) Alphaglucoside hydrolase inhibition in diabetes . Lancet 2 : 1386
5. Vierhapper H , Bratusch-Marrain P , Waldh~iusl W ( 1981 ) Long term treatment of sulphonylurea-treated diabetics with the alpha-glucosidase inhibitor Bay g 5421 (Acarbose ) Diabetologia 20 : 586 (Letter)