Acarbose in reactive hypoglycemia: a double-blind study.

Abstract

This study investigates the effect of Acarbose, a complex oligosaccharide of microbial origin with glucosidase-inhibiting properties in alimentary hypoglycemia secondary to rapid gastric emptying and in reactive hypoglycemia either isolated or associated with impaired glucose tolerance. Twenty-four patients complaining of symptoms suggesting hypoglycemia which occurred after meals and who showed blood glucose values of 2.5 mmol/l (45 mg/dl) or below on one or more occasions during a 5-h oral glucose tolerance test were selected and divided into three groups. Group I comprized seven patients with demonstrated rapid gastric emptying; group II comprized eight patients with impaired glucose tolerance, whereas the nine patients of group III were considered to present with "isolated reactive hypoglycemia" since they had a normal glucose tolerance and did not have either glycosuria or gastroduodenal pathology. All patients were submitted to two oral 75-g sucrose tolerance tests. Acarbose (100 mg) or placebo was ingested with the first drought of the sucrose solution administered in a randomized order. The investigation was performed in a double-blind manner. In all three groups Acarbose significantly reduced the magnitude of post-sucrose reactive hypoglycemia. The blood glucose nadir also occurred later, but this effect was statistically significant in group II only. In patients of groups II and III, such improvement of the glucose nadirs was preceded by a significant reduction of the post-sucrose glycemic peak. In all three groups, the insulin response to oral sucrose was reduced by Acarbose. Another consistent finding was the lack of sucrose-induced glucagon suppression when Acarbose was given. These data suggest that Acarbose might be a useful adjunct to the management of functional hypoglycemia.