Differential Effects of α-Glucosidase Inhibitors on Postprandial Plasma Glucose and Lipid Profile in Patients with Type 2 Diabetes Under Control with Insulin Lispro Mix 50/50

Background: The additive effect of alpha-glucosidase inhibitors (alpha-GIs) was investigated in patients with type 2 diabetes (T2D) under control with rapid-acting insulin analog. Subjects and Methods: Thirty-six poorly controlled T2D patients were recruited, and plasma glucose (PG) was controlled by three times daily injection of insulin lispro mix 50/50 (Mix50) to maintain fasting PG < 130 mg/dL and 2-h postprandial PG (PPG) < 180 mg/dL. Another group of 20 patients was randomly assigned to either 0.3 mg of voglibose or 50 mg of miglitol, which was administered at breakfast every other day. Another group of 16 patients was assigned to a crossover study, in which each alpha-GI was switched every day during the 6-day study. PPG, C-peptide, and lipid profile were analyzed. Results: The addition of voglibose had no effect on PPG, but miglitol blunted the PPG rise and significantly decreased 1-h and 2-h postprandial C-peptide levels compared with Mix50 alone. In addition, miglitol significantly decreased the 1-h postprandial triglyceride rise and the remnant-like particle-cholesterol rise, while it increased the 1-h postprandial high-density lipoprotein-cholesterol and apolipoprotein A-I levels in the crossover study. Conclusions: Miglitol appears to have rapid action, which appears earlier than that of lispro. The combination of miglitol and Mix50 seems effective for the control of PPG and lipid profile in T2D.