Acarbose

LITTLE ROCK, ARK. -- A landmark study demonstrating the efficacy of glyburide use in gestational diabetes mellitus has given the green light to investigations into the use of other oral hypoglycemic agents during pregnancy Dr. Thomas R. Moore said at the annual meeting of the North American Diabetes in Pregnancy Study Group.

"I really do think that adding insulin to an already hyperinsulinemic / resistant person is the wrong strategy and we should accelerate the search for and safety validation of agents which will modulate insulin resistance. These are presently oral agents, of course. Until then, we will be pouring insulin on the problem as the next best fix," Dr. Moore, professor and chairman of ob.gyn. at the University of California, San Diego, said in an interview

He and his associates are beginning a randomized trial of acarbose plus diet versus diet alone in 200 women with gestational diabetes to see whether the alpha-glucosidase inhibitor can reduce the number of women who need insulin or glyburide therapy

Previous studies have shown that while acarbose itself isn't absorbed through the gut, 35% of its breakdown products are. The drug, which works by delaying carbohydrate absorption when taken before meals, would be expected to lower postprandial glucose levels but probably does not affect fasting glucose, Dr. Moore said.

As for metformin, two recent studies have produced different safety results. In one involving 19 women with polycystic ovary syndrome, metformin therapy throughout pregnancy reduced the otherwise high rate of first-trimester spontaneous abortion associated with PCOS, apparently without teratogenic effects (Fertil. Steril. 75[1]:46-52, 2001).

In a Danish study however, the rate of preeclampsia was significantly higher among 50 diabetic women treated with metformin during the third trimester of pregnancy (32%), compared with 68 women treated with sulfonylureas (7%) or 42 who took insulin (10%). Perinatal mortality was also higher with metformin, compared with the other two groups (11.6% vs. 1.3%), but neonatal morbidity did not differ (Diabet. Med. 17[7]:507-11, 2000).

"More research is needed on metformin," Dr. Moore said in an interview.

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