Acarbose

Acarbose (INN) is an anti-diabetic drug used to treat diabetes mellitus type 2 and (in some countries), prediabetes. It is sold in Europe and China as Glucobay (Bayer AG), in North America as Precose (Bayer Pharmaceuticals), and in Canada as Prandase (Bayer AG). Acarbose is a starch blocker that works by inhibiting alpha glucosidase, an intestinal enzyme that releases glucose from larger carbohydrates such as starch and sucrose. It is composed of an acarviosin moiety with a maltose at the reducing terminus. It can be degraded by gut bacteria. Acarbose is inexpensive and popular in China, but not in the U.S. One physician explains that U.S. use is limited, because it is not potent enough to offset side effects of diarrhea and flatulence. However, a large 2013 study reported that "acarbose is effective, safe and well tolerated in a large cohort of Asian patients with type 2 diabetes." One possible explanation for the differing claims is that acarbose is significantly more effective in patients eating a relatively high-starch, Eastern diet.