Switching α-Glucosidase Inhibitors to Miglitol Reduced Glucose Fluctuations and Circulating Cardiovascular Disease Risk Factors in Type 2 Diabetic Japanese Patients

Background and Objectives In this study we examined the effects of switching alpha-glucosidase inhibitors (alpha-GI) from acarbose or voglibose to miglitol on glucose fluctuations and circulating concentrations of cardiovascular disease risk factors, such as soluble adhesion molecules (sE-selectin, sICAM-1 and sVCAM-1), a chemokine monocyte chemoattractant protein (MCP)-1, plasminogen activator inhibitor-1, and fatty acid-binding protein 4, in type 2 diabetic patients for 3 months. Methods We enrolled 47 Japanese patients with type 2 diabetes, with HbA(1c) levels with 7.26 +/- 0.5 % (mean +/- standard deviation), and who were treated with the highest approved dose of acarbose (100 mg/meal) or voglibose (0.3 mg/meal) in combination with insulin or sulfonylurea. Patients' prior alpha-GIs were switched to a medium dose of miglitol (50 mg/meal), and the new treatments were maintained for 3 months. Thirty-five patients who completed the 3-month study and provided serum samples were analyzed. Results The switch to miglitol for 3 months did not affect HbA(1c), fasting glucose, triglycerides, total-cholesterol or C-reactive protein levels, or result in any adverse events. Glucose fluctuations were significantly improved by the change in treatment (M-value: 10.54 +/- 4.32 to 8.36 +/- 2.54), while serum protein concentrations of MCP-1 (525.04 +/- 288.06-428.11 +/- 163.78 pg/mL) and sE-selectin (18.65 +/- 9.77-14.50 +/- 6.26 ng/mL) were suppressed. Conclusion Our results suggest that switching from acarbose or voglibose to miglitol for 3 months suppressed glucose fluctuations and serum protein levels of MCP-1 and sE-selectin in type 2 diabetic Japanese patients, with fewer adverse effects.