Miglitol: assessment of its role in the treatment of patients with diabetes mellitus

• Published in: The Annals of pharmacotherapy Vol. 34; no. 11; pp. 1291 - 1301
• Main Authors: Campbell, LK, Baker, DE, Campbell, RK
• Format: Journal Article
• Language: English
• Published: Cincinnati, OH Harvey Whitney Books 01-11-2000; SAGE Publications; Whitney
• Subjects: 1-Deoxynojirimycin - analogs & derivatives; Aged; Animals; Biological and medical sciences; Diabetes Mellitus - diet therapy; Diabetes Mellitus - drug therapy; Drug Administration Schedule; Drug Interactions; Glucosamine - adverse effects; Glucosamine - analogs & derivatives; Glucosamine - pharmacokinetics; Glucosamine - pharmacology; Glucosamine - therapeutic use; Glycated Hemoglobin A; Glycoside Hydrolase Inhibitors; Hormones. Endocrine system; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - pharmacokinetics; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Imino Pyranoses; Intestinal Absorption; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Randomized Controlled Trials as Topic; a -glucosidase inhibitor; diabetes mellitus; Glyset; miglitol; Endocrinopathy; Human; Drug combination; Enzyme; Toxicity; Treatment efficiency; Miglitol; Enzyme inhibitor; Review; Non insulin dependent diabetes; Chemotherapy; Hypoglycemic agent; Treatment; α-Glucosidase; Glycosidases; Hydrolases; Drug interaction; Mechanism of action; Pharmacokinetics; O-Glycosidases
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.19269

OBJECTIVE:
To evaluate miglitol, a new oral α-glucosidase inhibitor, and discuss its pharmacology, therapeutics, pharmacokinetics, dosing guidelines, adverse effects, drug interactions, and clinical efficacy.
DATA SOURCES:
A MEDLINE English-language only database search using the keywords miglitol, glyset, and Bay m 1099 (1985 to December 1999), was completed to identify relevant articles including reviews, recent studies, and abstracts; American Diabetes Association 1999 Annual Meeting abstracts; Pharmacia & Upjohn data on file and product information.
STUDY SELECTION:
The clinical trials that were selected to be reviewed in detail were randomized, double-blind studies with at least 100 patients in the intention-to-treat group.
DATA EXTRACTION:
All articles and abstracts were reviewed along with the product labeling from Pharmacia & Upjohn.
DATA SYNTHESIS:
Miglitol is an α-glucosidase inhibitor that exerts its effect through the delayed absorption of complex carbohydrates in the small intestine, resulting in a decrease in postprandial glucose concentrations that are directly correlated with the dietary carbohydrate content. Both small, short-term trials and large, clinical trials show a decrease in postprandial glucose concentrations and a modest decrease in glycosylated hemoglobin of approximately 0.5–1.0% as a result of miglitol's action. The adverse effects of miglitol are mild and transitory and include flatulence, diarrhea, and abdominal pain. The incidence of gastrointestinal problems may be reduced with a small initial dose, which is slowly titrated as tolerated.
CONCLUSIONS:
Miglitol is an effective and safe treatment option in patients with type 2 diabetes mellitus who are inadequately controlled with diet or oral sulfonylurea therapy. Miglitol is a good choice of therapy in Hispanic, African-American, and elderly patients, or any patients in whom hypoglycemia, weight gain, or lactic acidosis are risks. No published studies comparing miglitol with acarbose have been published, but there appears to be no major clinical or financial advantages to using one agent over the other.