What is the role of alpha-glucosidase inhibitors in the treatment of diabetic nephropathy?

Updated: Oct 09, 2019
  • Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Alpha-glucosidase inhibitors (acarbose, miglitol) decrease the breakdown of oligosaccharides and disaccharides in the small intestine, slowing the absorption of glucose after a meal. The major adverse effects are bloating, flatulence, and abdominal cramping.

Acarbose is minimally absorbed, with less than 2% of the drug and active metabolites present in the urine. However, in patients with reduced renal function, serum levels of acarbose and metabolites are significantly higher. Miglitol has greater systemic absorption with greater than 95% renal excretion. It is recommended that miglitol be avoided if the GFR is less than 25 mL/min/1.73 m2. [30] These drugs have not been studied in patients with advanced kidney disease, and their use should be avoided in this population.


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