Analysis of α-glucosidase inhibitors: How can they assist in weight loss treatment for diabetic patients?

α-Glucosidase Inhibitors

1. Pharmacological Actions
α-Glucosidase inhibitors mainly act on the brush border of the small intestine, competitively inhibiting α-amylase, glucosylamylase, and sucrase, preventing the hydrolysis of 1,4-glycosidic bonds, delaying the absorption of starch, sucrose, and maltose, and reducing postprandial blood glucose, thereby reducing stimulation of the pancreas. Long-term use can improve blood lipids, reduce plasma insulin and C-peptide levels, and improve the body's insulin sensitivity. Used alone, it does not cause hypoglycemia or affect weight.

2. Drugs and Hypoglycemic Applications

(1) Acarbose (Glucobay) (See Chapter 8, Section 2, Weight Loss Drugs) Acarbose preparations are available in 50mg tablets. The initial treatment dose is 50mg, three times daily, and then adjusted according to postprandial blood glucose levels one hour after meals. Most people achieve good results with 100mg, three times daily, taken as the first bite of each main meal. The main side effects are bloating and borborygmus caused by the fermentation of undigested carbohydrates. These can be controlled by slowly increasing the dose and controlling diet, and most disappear with continued treatment. This medication is not suitable for patients with intestinal diseases that impair digestion and absorption, or for pregnant or breastfeeding women.

(2) Miglitol: The formulation is 50mg/tablet. Take 50mg three times daily with meals. This dosage has the same hypoglycemic effect as Glucobay (100mg three times daily). Miglitol significantly reduces glucose absorption, while acarbose does not. Furthermore, miglitol has significantly fewer side effects than Glucobay. Side effects of miglitol include hot flashes and abdominal discomfort, which subside rapidly after discontinuation.

(3) Voglibose (Beixin): The formulation is 0.2mg tablets. The initial treatment dose is generally 0.2 mg three times daily. If the effect is not significant, the dose can be increased to 0.3 mg three times daily. Voglibose has a very strong inhibitory effect on maltase and sucrase in the small intestine. In vitro experiments show that its inhibitory effect on maltase and sucrase is 270 times and 190 times that of Glucobay, respectively, while having almost no inhibitory effect on Sherwin α-amylase. Small doses of voglibose can reduce the peak of the blood glucose curve and correspondingly reduce gastrointestinal side effects.