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Diabetes Treatment (cont.)

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Medications that decrease the absorption of carbohydrates from the intestine (Precose)

Before being absorbed into the bloodstream, carbohydrates must be broken down into smaller sugar particles, such as glucose, by enzymes in the small intestine. One of the enzymes involved in breaking down carbohydrates is called alpha glucosidase. By inhibiting this enzyme, carbohydrates are not broken down as efficiently and glucose absorption is delayed.


The name of the alpha glucosidase inhibitor available in the U.S. is acarbose (Precose). In clinical trials with over 700 patients, the use of Precose was associated with a reduction in hemoglobin A1c values (a well-known measurement of average blood sugars over the preceding three months) that was significantly greater than the use of placebo (no treatment). However, as a single agent, Precose is not as effective as the other medications for diabetes. Since Precose works in the intestine, its effects are additive to diabetic medications that work at other sites, such as sulfonylureas. Clinical studies have shown statistically better control of blood glucose in patients treated with Precose and a sulfonylurea compared to the sulfonylurea alone. Precose is currently used alone or in combination with a sulfonylurea.

Precose is taken three times a day at the beginning of meals. The dosage varies from 25 to 100mg with each meal. The maximum recommended dose is 100mg three times a day. At doses greater than this, reversible abnormalities in liver tests may be seen. Because of its mechanism of action, Precose has significant gastrointestinal side effects. Abdominal pain, diarrhea, and gas are common and are seen in up to 75% of patients taking Precose. For this reason, Precose is administered using a low initial dose that is increased over weeks depending on the patient's tolerance. Most of the gastrointestinal symptoms tend to subside over the course of a few weeks although some patients report persistent problems.


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