Comparison of the effects of acarbose and metformin use on ovulation rates in clomiphene citrate-resistant polycystic ovary syndrome

BACKGROUND: The aim of this study was to evaluate the effects of metformin and acarbose on insulin resistance, hormone profiles and ovulation rates in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). METHODS: Thirty clomiphene citrate-resistant patients were selected randomly and divided into two groups. Group I was treated with 100 mg/day clomiphene citrate and 300 mg/day acarbose 100 mg/day orally, for 3 months. Group II was treated with clomiphene citrate 100 mg/day and metformin 1700 mg/day orally, for 3 months. Serum fasting insulin and glucose, FSH, LH, estradiol, progesterone, prolactin and total testosterone levels plus body mass index (BMI) were measured before and after treatment. Follicle growth was followed by transvaginal ultrasonography. RESULTS: LH:FSH ratio and total testosterone concentrations decreased (P<0.05) and ovulation rates increased in both groups. Reduction in weight and BMI was only significant in the acarbose group. CONCLUSIONS: Both treatment modalities were effective in the treatment of insulin resistance and improving ovulation rates. Increase in the number of eumenorrhoeic and normoinsulinaemic cases and decrease in the number of insulin-resistant cases were significant in both groups (P<0.05). Ovulation rate was greater in the metformin group in the second month of therapy (P<0.05). Acarbose was found to be a safe and effective agent that could be used in cases with clomiphene-resistant PCOS.     

阿卡波糖对2型糖尿病病人胰岛素抵抗的影响

目的 :探讨阿卡波糖对 2型糖尿病病人胰岛素抵抗的影响。方法 :16 0例 2型糖尿病病人随机分为 2组 ,治疗组 80例口服阿卡波糖治疗 ,前 2wk ,5 0mg ,po ,tid ,2wk后 ,10 0mg ,po ,tid ;安慰剂组 80例口服安慰剂 ,方法同治疗组 ,疗程为 2 4wk。同时观察空腹及餐后 2h血糖、血清胰岛素水平、体重指数、糖化血红蛋白、空腹时的红细胞胰岛素受体和红细胞膜流动性治疗前后变化。结果 :(1)wk 4时 ,阿卡波糖明显降低病人的空腹血糖、餐后 2h血糖、糖化血红蛋白 ,下降值分别为 :(2 .9±s 0 .8)mmol·L- 1,(4.0± 1.8)mmol·L- 1,(1.2± 2 .1) % ,P<0 .0 1;(2 ) 2 4wk后 ,阿卡波糖降低病人的体重、空腹血清胰岛素、餐后 2h血清胰岛素 ,下降值分别为 :(6± 4 )kg·m- 2 ,(10± 6 )MIU·L- 1,(14± 10 )MIU·L- 1,增加红细胞胰岛素受体 ,升高值为 :(80± 71)sites·RBC- 1,降低膜流动性 ,下降值为 :(1.5± 1.3) ,P <0 .0 1。结论 :阿卡波糖能改善 2型糖尿病病人的胰岛素抵抗     

口服阿卡波糖出现药疹1例

阿卡波糖(acarbose)为近年来临床上应用较广泛的降糖药，属α葡萄糖苷酶抑制剂，通过竞争抑制肠细胞刷状缘内的α葡萄糖苷酶，延迟蔗糖、糊糖、麦芽糖等多糖分解成单糖，并延迟葡萄糖在肠道的吸收，对餐后高血糖和高胰岛素血症效果较好。阿卡波糖的不良反应主要为肠胀气，皮肤损害较少见。我院应用阿卡波糖口服后出现双手大片药疹1例，现报道如下。     

阿卡波糖对2型糖尿病合并冠心病病人餐后代谢和内皮功能的影响

目的 :研究阿卡波糖对 2型糖尿病合并冠心病病人餐后代谢及内皮功能的影响。方法 :6 0例2型糖尿病合并冠心病病人分为 2组 ,治疗组予格列齐特和阿卡波糖口服 ;对照组予格列齐特口服 ,疗程均为 6wk。结果 :治疗后 ,2组空腹血糖、餐后 2h血糖、餐后 4h三酰甘油均明显下降 ,治疗组下降幅度较大。治疗组一氧化氮从 (76±s 31) μmol·L- 1上升至 (12 3± 6 0 ) μmol·L- 1,内皮素从 (71± 2 2 )ng·L- 1下降至 (5 4± 2 3)ng·L- 1,与对照组相比差异有非常显著意义 (P <0 .0 1) ,内皮依赖性血管舒张功能亦改善。结论 :阿卡波糖可以改善 2型糖尿病合并冠心病病人餐后代谢及内皮功能。     

Effect of Acarbose on Vascular Disease in Patients with Abnormal Glucose Tolerance

INTRODUCTION: Excessive postprandial (pp) glucose excursion in people with IGT and type 2 diabetes is associated with a cascade of proatherogenic events. Acarbose, a potent competitive inhibitor of alpha-glucosidases of the small intestine specifically reduces pp hyperglycemia with an average reduction of HbA1c by 0.8% in Cochrane metaanalysis. This is associated with pleiotropic effects on a broad spectrum of cardiovascular (CV) risk factors: reduction of overweight, lowering of blood pressure, triglycerides, hsCRP, fibrinogen and other biomarkers of low grade inflammation. RESULTS AND DISCUSSION: Flow mediated vasodilation was improved and progression of intima media thickness was reduced by acarbose. In the STOP-NIDDM trial in people with IGT acarbose decreased the incidence of diabetes by 36%. The STOP-NIDDM trial with CV events as secondary objective is the only intervention trial in people with IGT so far with a significant benefit for CV disease inclusive hypertension. In a metaanalysis of controlled studies (MeRIA) in patients with type 2 diabetes, treatment with acarbose was associated with a 64% lower rate of myocardial infarction and 35% less CV events. CONCLUSION: Thus results so far available prove that acarbose is an effective and safe drug to treat abnormal glucose tolerance. They suggest that acarbose can help to control a broad spectrum of CV risk factors and may prevent CV disease.     

Hypoglycemia Worsened by Glucose Administration: A Case of Hypoglycemia Years After Gastric Surgery

BackgroundNoninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a rare syndrome characterized by postprandial hypoglycemia with neuroglycopenic symptoms occurring 1 to 3 h after a meal. Diagnosis can be elusive, as the vast majority of patients have normal fasting blood glucose levels, and onset of hypoglycemic episodes can be a late complication of gastric surgery.Case ReportWe report the case of a 45-year-old woman presenting to the Emergency Department (ED) with new-onset seizures and hypoglycemia worsened by glucose administration. Surgical history is pertinent for a Roux-en-Y gastric bypass approximately 10 years prior to presentation.Why Should an Emergency Physician Be Aware of This?Although rare, it is important for emergency physicians to be vigilant of this disease process as a traditional treatment approach for hypoglycemia may be detrimental. Although cases of NIPHS have been documented in literature, its presence in emergency medicine-specific literature is seemingly nonexistent. Noninvasive imaging techniques will be normal, and diagnosis is dependent on awareness of this disease entity coupled with a detailed history.     

阿卡波糖联合甘精胰岛素治疗2型糖尿病效果的Meta分析

目的:系统评价阿卡波糖联合甘精胰岛素治疗2型糖尿病的效果。方法:系统检索PubMed、EMbase、Web of Science、中国知网、万方、维普、中国生物医学文献数据库中关于使用阿卡波糖联合甘精胰岛素治疗2型糖尿病病人的随机对照试验,检索时间为建库至2020年4月1日。按照纳入及排除标准筛选文献、提取资料并评价纳入文献的方法学质量。采用RevMan 5.3进行Meta分析。结果:共纳入21项研究,Meta分析结果显示:阿卡波糖联合甘精胰岛素可以降低2型糖尿病病人空腹血糖[MD=-0.98,95%CI(-1.27,-0.70),P<0.00001]、餐后2 h血糖[MD=-1.10,95%CI(-1.47,-0.72),P<0.00001]及糖化血红蛋白[SMD=-0.97,95%CI(-1.30,-0.65),P<0.00001]。结论:现有证据表明阿卡波糖联合甘精胰岛素可降低2型糖尿病病人空腹血糖、餐后2 h血糖及糖化血红蛋白。     

Influence of gallic acid on α-amylase and α-glucosidase inhibitory properties of acarbose

Acarbose is an antidiabetic drug which acts by inhibiting α-amylase and α-glucosidase activities but with deleterious side effects. Gallic acid (GA) is a phenolic acid that is widespread in plant foods. We therefore investigated the influence of GA on α-amylase and α-glucosidase inhibitory properties of acarbose (in vitro). Aqueous solutions of acarbose and GA were prepared to a final concentration of 25μM each. Thereafter, mixtures of the samples (50% acarbose + 50% GA; 75% acarbose + 25% GA; and 25% acarbose + 75% GA) were prepared. The results revealed that the combination of 50% acarbose and 50% GA showed the highest α-glucosidase inhibitory effect, while 75% acarbose + 25% GA showed the highest α-amylase inhibitory effect. Furthermore, all the samples caused the inhibition of Fe²⁺-induced lipid peroxidation (in vitro) in rat pancreatic tissue homogenate, with the combination of 50% acarbose and 50% GA causing the highest inhibition. All the samples also showed antioxidant properties (reducing property, 2,2′-azino-bis (-3-ethylbenzthiazoline-6-sulphonate [ABTS*] and 1,1-diphenyl-2-picrylhydrazyl [DPPH] free radicals scavenging abilities, and Fe²⁺ chelating ability). Therefore, combinations of GA with acarbose could be employed as antidiabetic therapy, with a possible reduction of side effects of acarbose; nevertheless, the combination of 50% acarbose and 50% GA seems the best.     

Safe and effective treatment of diabetes mellitus associated with chronic liver diseases with an alpha-glucosidase inhibitor, acarbose

Glucose intolerance and diabetes mellitus are both prevalent in patients with chronic liver diseases. We examined the efficacy and systemic safety of therapy with an alpha-glucosidase inhibitor, acarbose, in diabetes mellitus associated with chronic liver diseases. Twenty patients with chronic hepatitis or liver cirrhosis and overt diabetes mellitus received acarbose (taken orally) for 8 weeks. The initial dosage of acarbose was 50mg three times daily, taken before meals; this was increased to 100mg three times daily after 2 weeks. The mean fasting plasma glucose level was 173.7±18.6mg/dl (mean±SE) at entry, and was significantly decreased to 132.9±7.5mg/dl (P<0.05) after 8 weeks of acarbose treatment. The improved glycemic control was reflected by a significant decrease in glycosylated hemoglobin (HbA1c) from 7.2±0.3% at entry to 6.3±0.2% (P<0.05) after 8 weeks. Serum levels of both aspartate and alanine aminotransferases fluctuated during acarbose treatment, probably due to the natural course of chronic liver diseases, but the mean values had decreased after 8 weeks of treatment. Plasma ammonia levels increased, from 61.3±10.7μg/dl to 71.1±9.6μg/dl after 8 weeks of acarbose treatment but the increase was not significant. Clinically significant elevation of plasma ammonia concentration was seen in 2 cirrhotic patients (121 and 124μg/dl); this was asymptomatic and gradually returned to the normal range despite continuous acarbose treatment in one patient, and was reversed after the withdrawal of acarbose with the concomitant administration of lactulose in the other patient. No other blood tests results, including albumin, cholinesterase, and prothrombin time, or lipid profile and nutritional status, in terms of rapid turnover proteins, prealbumin, retinol binding protein, and transferrin, were altered throughout the study period. These results indicate that diabetes mellitus associated with chronic liver diseases may be safely and effectively treated with acarbose. However, clinicians must be aware of the possibility of hyperammonemia when they prescribe acarbose for patients with diabetes mellitus and advanced liver cirrhosis.     

迟发性倾倒综合征导致的严重低血糖一例报告

倾倒综合征是食管、胃及减肥手术后常见的并发症。本文介绍胃贲门癌术后8年因反复严重低血糖就诊的迟发性倾倒综合征１例,对患者予以阿卡波糖治疗后血糖控制稳定;随访2年,未再出现过乏力、心慌等低血糖反应。本研究旨在探讨迟发性倾倒综合征的诊断、治疗方法等,以提高对该疾病的认识。