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Alpha-Glucosidase Inhibitor Is Drug of Choice for Diabetics Wit

Treatment with an alpha-glucosidase inhibitor may be particularly beneficial for patients with type 2 diabetes An alpha-glucosidase inhibitor, acarbose, may be preferable to a sulfonylurea, glibenclamide, in patients with type 2 diabetes mellitus and systolic hypertension, German investigators report in Clinical Drug Investigations for October.

Drs. Julian H. Rosenthal and Herbert Mauersberger, of the Ulm University Medical Center, randomized 76 patients, mean age 57.5 years, to treatment with acarbose or glibenclamide for 6 months. All patients had type 2 diabetes and were mildly hypertensive and overweight.

Following a 4-week washout phase, acarbose was initiated at 50 mg t.i.d. and titrated up to 100 mg t.i.d. Glibenclamide was titrated from a starting dose of 1.75 mg/day to an average of 5.1 mg/day, maximum 10.5 mg/day.

Among the 32 patients who completed the acarbose arm of the study, systolic blood pressure decreased more than among the 31 who finished the glibenclamide arm (-5.2 versus -1.6 mm Hg, respectively, p = 0.0001).

In contrast, average diastolic blood pressure fell more in the glibenclamide group (-5.5 versus -2.4 mm Hg, p = 0.003).

Fasting triglyceride levels decreased by 12.0 mg/dL with acarbose while increasing by 14.6 mg/dL with glibenclamide.

Glycemic control was similar between the two groups. Serum insulin levels were significantly lower with acarbose therapy (p < 0.05).

The authors partially attribute the differential effects on systolic blood pressure to insulin’s stimulation of the sympathetic nervous system. This theory, they say, is supported by the significantly greater reduction in heart rate in the acarbose group (from 79.5 beats/min at baseline to 75.9 beats/min at 6 months) compared with the relative stability of this measure in the glibenclamide group (80.8 to 81.3 beats/min).

Given the epidemiologic evidence for strong correlations between mortality, systolic blood pressure and heart rate, Drs. Rosenthal and Mauersberger suggest that "in addition to lifestyle modification, treatment with an alpha-glucosidase inhibitor may be particularly beneficial for patients with type 2 diabetes mellitus and primarily isolated systolic hypertension." Clin Drug Invest 2002;22:695-701.