Single administration of alpha-glucosidase inhibitors on endothelial function and incretin secretion in diabetic patients with coronary artery disease - Juntendo University trial: effects of miglitol on endothelial vascular reactivity in type 2 diabetic patients with coronary heart disease (J-MACH) -.
BACKGROUND
Post-prandial hyperglycemia, hyperlipidemia, and endothelial dysfunction play an important role in the pathogenesis of atherosclerosis. Improvement in post-prandial hyperglycemia on alpha-glucosidase inhibitors (alpha-GIs) is associated with a risk reduction of cardiovascular diseases, but the post-prandial effects of alpha-GIs on endothelial function and incretin secretion in type 2 diabetic patients with coronary artery disease (CAD) remain unclear.


RESULTS
The post-prandial effects of a single administration of miglitol and voglibose on endothelial function and changing levels of glucose, insulin, lipids, glucagon-like peptide (GLP)-1, and gastric inhibitory polypeptide (GIP) were compared after a standard meal loading in 11 diabetic patients with CAD, using a placebo-controlled cross-over design. The changing levels of glucose, insulin and triglycerides at 60 min were significantly lower in the miglitol group than in the voglibose and placebo groups (all P<0.01). GLP-1 levels were significantly higher at 120 min (P<0.05) and GIP levels were significantly lower at 30 min and 60 min (P<0.05) in the miglitol group compared to other treatments. The reactive hyperemia duration at 120 min was significantly maintained in the miglitol group compared to the other groups.


CONCLUSIONS
A single administration of miglitol significantly improved post-prandial glucose/lipid metabolism, incretin secretion, and endothelial dysfunction in diabetic patients with CAD, suggesting that miglitol may be a useful anti-atherogenic agent (UMIN000002264).
Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Makoto
M
Hiki
Kazunori
K
Shimada
Takashi
T
Kiyanagi
Kosuke
K
Fukao
Kuniaki
K
Hirose
Hiromichi
H
Ohsaka
Yoshifumi
Y
Fukushima
Atsumi
A
Kume
Rie
R
Matsumori
Katsuhiko
K
Sumiyoshi
Tetsuro
T
Miyazaki
Hirotoshi
H
Ohmura
Takeshi
T
Kurata
Takashi
T
Miida
Hiroyuki
H
Daida
D017485:1-Deoxynojirimycin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000368:Aged; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000209:etiology; D003327:Coronary Disease / Q000188:drug therapy* / Q000209:etiology; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D004311:Double-Blind Method; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D005260:Female; D005947:Glucose / Q000378:metabolism; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D054795:Incretins / Q000378:metabolism*; D007294:Inositol / Q000008:administration & dosage / Q000031:analogs & derivatives; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D054795:Incretins; C045621:miglitol; D017485:1-Deoxynojirimycin; D007294:Inositol; D005947:Glucose; C102817:voglibose