Efficacy of α-glucosidase inhibitors combined with dipeptidyl-peptidase-4 inhibitor (alogliptin) for glucose fluctuation in patients with type 2 diabetes mellitus by continuous glucose monitoring.
OBJECTIVE
The combination therapy of dipeptidyl-peptidase (DPP)-4 inhibitor and α-glucosidase inhibitors (α-GIs) is highly effective in suppressing postprandial hyperglycemia. The aim of the present study was to compare the effects of voglibose and miglitol on glucose fluctuation, when used in combination with DPP-4 inhibitor by using continuous glucose monitoring (CGM).


METHODS
In a randomized cross-over study, 16 patients with type 2 diabetes who presented with postprandial hyperglycemia despite alogliptin (25 mg) were treated with voglibose (0.9 mg) or miglitol (150 mg). We measured standard deviation (SD); mean amplitude of glycemic excursions (MAGE), and mean, minimum and maximum glucose measured by CGM during three phases (alogliptin monotherapy, dual therapy of alogliptin and voglibose, and dual therapy of alogliptin and miglitol). The primary outcome measure was SD between α-GIs.


RESULTS
SD was significantly improved by the addition of either voglibose (18.9 ± 10.1) or miglitol (19.6 ± 8.2) to alogliptin monotherapy (36.2 ± 8.7). MAGE improved significantly with the addition of either voglibose (57.5 ± 26.1, P < 0.01) or miglitol (64.6 ± 26.2, P < 0.01) to alogliptin monotherapy (101.5 ± 21.5). There was no significant difference in glucose fluctuation between α-GIs. There were no differences between two groups in mean (132.6 ± 21.4 and 138.7 ± 25.4) and maximum (184.3 ± 48.7 and 191.9 ± 38.3). The minimum glucose under alogliptin plus voglibose (94.9 ± 20.2) was significantly lower than that under alogliptin and miglitol (105.3 ± 21.0).


CONCLUSIONS
Glucose fluctuation was improved by the addition of voglibose or miglitol to alogliptin. Glucose fluctuations and postprandial hyperglycemia were similar between α-GIs. This trial was registered with the University Hospital Medical Information Network (no. UMIN R000010028).
First Department of Internal Medicine School of Medicine, University of Occupational and Environmental Health Japan Kitakyushu Japan.
Akira
A
Kurozumi
First Department of Internal Medicine School of Medicine, University of Occupational and Environmental Health Japan Kitakyushu Japan.
Yosuke
Y
Okada
First Department of Internal Medicine School of Medicine, University of Occupational and Environmental Health Japan Kitakyushu Japan.
Hiroko
H
Mori
First Department of Internal Medicine School of Medicine, University of Occupational and Environmental Health Japan Kitakyushu Japan.
Tadashi
T
Arao
First Department of Internal Medicine School of Medicine, University of Occupational and Environmental Health Japan Kitakyushu Japan.
Yoshiya
Y
Tanaka
Alpha‐glucosidase inhibitor; Continuous glucose monitoring; Dipeptidyl‐peptidase‐4 inhibitor