Content Sources:
1. "Mechanism of action and clinical application of acarbose in the treatment of type 2 diabetes", Chinese Journal of Diabetes, 2019.
2. "Effect of acarbose on postprandial glycemic control in patients with type 2 diabetes", Chinese Journal of Practical Internal Medicine, 2020.
3. "The effect of acarbose on the gut microbiome and its role in the treatment of type 2 diabetes", Acta Microbiologica Sinica, 2021.
Diabetes has unknowingly become an important disease that threatens our health, especially the middle-aged and elderly, who are easy to become the direct audience of this disease, which makes people feel very powerless. The main reason why people feel scared about diabetes is that they need to take medication for life, and they must be careful of the complications caused by diabetes at all times.
Among the drugs used to treat diabetes, there is a drug called acarbose that is particularly popular, and many people are very curious about the magic of taking a small pill.
1. The hypoglycemic principle of acarbose
1. Inhibition of α-glucosidase activity
Acarbose works by acting directly on the α-glucosidase enzymes in the lining of the small intestine, which are key to breaking down carbohydrates to facilitate their absorption. Acarbose forms a complex with these enzymes, which prevents them from breaking down macromolecular carbohydrates in foods such as sucrose and starch, reducing the rate of glucose production. This effect reduces glucose absorption in the small intestine, which in turn lowers postprandial blood sugar levels.
2. Affects intestinal flora
Acarbose inhibits glucose production and absorption, increasing the flow of undigested carbohydrates into the large intestine, where these carbohydrates are fermented by gut microbes to produce short-chain fatty acids. Short-chain fatty acids are thought to improve gut health and have a positive impact on overall metabolic status, including increased insulin sensitivity and regulation of blood sugar levels. Therefore, although this mechanism does not directly act on the reduction of blood glucose, it has an indirect effect on blood sugar control in diabetic patients.
3. Slows down postprandial blood sugar response
Since acarbose is effective in reducing the rate of postprandial glucose production, it can also alleviate the sharp rise in blood sugar after a meal. For people with type 2 diabetes, postprandial hyperglycemia is one of the problems that must be strictly controlled. By slowing down the digestion of carbohydrates, acarbose reduces the burden on the β cells of pancreatic islets and helps to improve the response to insulin secretion, thereby preventing or delaying the progression of diabetes to a certain extent.
2. Precautions for taking acarbose
Acarbose, as a commonly used hypoglycemic drug, is widely used in the treatment of type 2 diabetes. Its mechanism of action is mainly by inhibiting the activity of intestinal α-glucosidase, slowing down the absorption of glucose, and then achieving the purpose of reducing postprandial blood glucose levels. Although acarbose is a drug with significant effects, there are still the following aspects that need to be paid attention to during use.
1. Take it properly as directed by your doctor
The dosage of acarbose needs to be adjusted according to the patient's glycemic control and tolerance, so the first thing to do is to follow your doctor's advice and not adjust the dose on your own. It is important to note that acarbose needs to be taken with a meal because it exerts its hypoglycemic effect by acting on carbohydrates in food. If you miss a meal, you should skip the dose.
In addition, acarbose may affect the absorption of other medications, so you should also consult your doctor or pharmacist before using other medications to ensure that there are no adverse interactions between the drugs.
2. Pay attention to dietary management
Although acarbose can slow down carbohydrate absorption, it does not mean that patients can consume high-sugar or high-carbohydrate foods without moderation. Proper dietary management is an important part of diabetes treatment. Patients should follow a balanced diet while taking acarbose.
3. Monitor blood sugar and recognize side effects
Monitoring blood glucose is critical during acarbose use, especially at the beginning of treatment or during dose adjustments. Monitoring of blood glucose can help assess the efficacy and safety of the drug and adjust the treatment regimen in a timely manner.
At the same time, it is important to recognize and face the potential side effects of acarbose. Common side effects include gastrointestinal upset, diarrhoea, abdominal pain and bloating, which are mainly caused by unabsorbed carbohydrates fermenting in the large intestine.
To alleviate these side effects, patients can try to start with a lower dose and gradually increase the dose to allow the body to adapt. At the same time, a balanced diet that reduces the intake of fermentable carbohydrates, such as fine sugars and certain starchy foods, can also help reduce gastrointestinal reactions.
3. Applicable symptoms of acarbose
First of all, acarbose is especially suitable for diabetics who value postprandial blood sugar control. Elevated postprandial blood sugar is one of the main problems faced by patients with type 2 diabetes, and maintaining a high level of postprandial blood sugar over a long period of time will increase the risk of cardiovascular diseases such as heart disease and stroke. By slowing down the absorption of carbohydrates, acarbose can effectively control postprandial blood glucose levels, which is of great significance for improving the long-term blood glucose control indicators of patients.
Secondly, acarbose is also suitable for people with type 2 diabetes who need weight management. Obesity is one of the main causes of type 2 diabetes, and weight loss plays an important role in improving insulin sensitivity and controlling blood sugar levels. Acarbose is especially beneficial for people with diabetes who need weight control because it reduces the absorption of some carbohydrates and indirectly helps control energy intake.
Third, the addition of acarbose may further improve glycemic control in patients who are already taking other types of glucose-lowering drugs such as insulin, sulfonylureas, or dipeptidyl peptidase-4 (DPP-4) inhibitors but still have suboptimal glycemic control.
Since the mechanism of action of acarbose is different from most other hypoglycemic drugs, it can be used in combination with these drugs to achieve a better hypoglycemic effect. Moreover, due to the specificity of acarbose's mechanism of action, it does not increase the risk of hypoglycemia, which is an important advantage for patients who are undergoing intensive glucose-lowering therapy and who have concerns about hypoglycemia.
However, despite the above-mentioned advantages, there are certain limitations and side effects associated with its use, the most common of which are digestive symptoms such as diarrhea, bloating, gas, etc., which are caused by the fermentation of unabsorbed carbohydrates in the intestines. Therefore, when using acarbose, patients need to adjust their dietary habits appropriately and reduce the intake of foods that are prone to side effects under the guidance of their doctors.