● Patients with T2DM are at increased risk for cardiovascular disease-related morbidity and mortality as compared with healthy individuals. A relationship between the postprandial metabolic state and atherogenesis has been demonstrated and has also been documented in T2DM patients.
● It has been suggested that postprandial hyperglycaemia may be an independent risk factor for cardiovascular disease. Moreover, large-scale clinical trials, such as the Diabetes.
Epidemiology: Collaborative analysis of Diagnostic criteria in Europe (DECODE) study, have shown that postprandial hyperglycaemia is a risk factor for arteriosclerosis, independent of other established risk factors such as hypertension and hyperlipidemia.
● In the Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM), treatment with an α-glucosidase inhibitor (α-GI) in patients with impaired glucose tolerance (IGT) not only reduced the rate of conversion to T2DM, but was also associated with a reduction in the risk of cardiovascular events.
● These results suggested the importance of treating postprandial hyperglycemia in the early stages of T2DM. Although sulphonylureas (SU) have been widely used for the treatment of DM, they do not act rapidly enough to increase glucose-stimulated insulin secretion after a meal and are, therefore, insufficient to control postprandial hyperglycaemia. Since it has been shown that SU can easily cause prolonged hyperglycaemia. and weight gain, they have to be used with caution in the early stages of T2DM.
● Although glinides are insulin secretagogues that bind to the SU receptors of pancreatic β-cells as well, they can facilitate rapid insulin secretion, restore postprandial early insulin secretion, and reduce the postprandial glucose spike. On the other hand, α-GI reduces postprandial hyperglycemia and insulin secretion by delaying the digestion of carbohydrates in the small intestine.
● Both glinides and α-GI have beneficial effects for treating patients with T2DM and IGT.
● Considering the ameliorating effects of these drugs on postprandial metabolic disorders, combinations of glinides and α-GI might constitute a promising therapeutic approach for patients with T2DM.
● Although Voglibose exerts a slightly less potent effect in reducing postprandial hyperglycemia than Acarbose and Miglitol, it has the advantage of fewer gastrointestinal adverse events. Therefore, Voglibose is widely used in Japan to reduce postprandial hyperglycemia in both T2DM and IGT patients.
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