The efficacy and tolerability of intermittent prandial acarbose to reduce glucose spikes in healthy individuals

Abstract

Acarbose is an α-glucosidase inhibitor that slows the digestion of carbohydrates and can prevent sharp increases in blood sugar levels after meals (spikes). Excessive postprandial blood glucose spikes have been associated with chronic conditions, increase all-cause mortality, and may contribute to aging. Therefore, the prevention of glucose spikes may contribute to the preservation of human healthspan. Indeed, acarbose has been associated with increased lifespan in animal models. However, its tolerability profile has limited acarbose use in healthy individuals. We hypothesized that using low-dose acarbose right before the occasional high-carbohydrate meal may prevent glucose spikes in healthy individuals. We performed a prospective clinical study to evaluate the tolerability and efficacy of acarbose in healthy individuals. Participants were randomized into two arms, each performing two control tests and two treatment tests. Continuous glucose monitor (CGM) measurements were collected for 2 h after high carbohydrate meals with or without pre-meal 50 mg acarbose intake. Tolerability was assessed using questionnaires. Twelve patients had evaluable results. Acarbose pretreatment resulted in reductions in CGM glucose measurements, with a significant decrease in glucose levels at the start, after 15 min, and at peak glucose levels. Few participants reported acarbose adverse events, and these included flatulence, bloating, nausea, abdominal pain, and stomach aches. No statistical difference in tolerability was detected between periods with and without acarbose. In conclusion, treatment with 50 mg of acarbose before meals was found to be well tolerated and efficacious in blunting the postprandial glucose spike by over 17% in healthy individuals.