Metformin/acarbose

An overview of the combination therapy using Metformin and Acarbose in the management of type 2 diabetes mellitus.

Introduction

Metformin and acarbose are two oral medications commonly used in the management of type 2 diabetes mellitus. Both drugs have distinct mechanisms of action and are often used in combination to achieve better glycemic control. This article provides a comprehensive overview of the pharmacology, clinical use, and potential side effects of metformin and acarbose when used together.

Pharmacology

Metformin

Metformin is a biguanide class medication that primarily works by decreasing hepatic glucose production and improving insulin sensitivity in peripheral tissues. It is often the first-line treatment for type 2 diabetes due to its efficacy, safety profile, and potential cardiovascular benefits. Metformin does not cause hypoglycemia when used as monotherapy.

Acarbose

Acarbose is an alpha-glucosidase inhibitor that delays the digestion and absorption of carbohydrates in the small intestine. By inhibiting the enzyme alpha-glucosidase, acarbose reduces postprandial blood glucose levels. It is particularly useful in managing postprandial hyperglycemia.

Clinical Use

The combination of metformin and acarbose is used to enhance glycemic control in patients with type 2 diabetes. Metformin addresses fasting blood glucose levels, while acarbose targets postprandial spikes. This complementary action can lead to improved overall glycemic control.

Indications

The combination therapy is indicated for patients with type 2 diabetes who do not achieve adequate glycemic control with metformin alone. It may also be considered in patients who experience significant postprandial hyperglycemia.

Dosage and Administration

Metformin is typically started at a low dose, such as 500 mg once or twice daily, and gradually increased based on tolerance and glycemic response. Acarbose is usually initiated at 25 mg with the first bite of each main meal and can be titrated up to 100 mg three times daily.

Side Effects

Metformin

Common side effects of metformin include gastrointestinal disturbances such as diarrhea, nausea, and abdominal discomfort. Rarely, it can cause lactic acidosis, a serious condition that requires immediate medical attention.

Acarbose

Acarbose is associated with gastrointestinal side effects, including flatulence, diarrhea, and abdominal pain, due to fermentation of undigested carbohydrates in the colon. These side effects often diminish with continued use.

Contraindications

The combination of metformin and acarbose is contraindicated in patients with:

• Severe renal impairment
• Gastrointestinal disorders such as inflammatory bowel disease or intestinal obstruction
• Known hypersensitivity to either drug

Monitoring

Patients on metformin and acarbose should have regular monitoring of blood glucose levels, renal function, and liver enzymes. Monitoring helps ensure efficacy and safety of the treatment regimen.

Conclusion

The combination of metformin and acarbose offers a synergistic approach to managing type 2 diabetes by targeting both fasting and postprandial blood glucose levels. While effective, it requires careful consideration of side effects and contraindications.

Also see

• Type 2 diabetes mellitus
• Oral hypoglycemic agents
• Insulin therapy
• Diabetes management