Update in the treatment of type 2 diabetes mellitus.: The α-glucosidase inhibitors.

The development of antidiabetic drugs with complementary mechanisms of action appears more and more necessary in order to achieve durable glycaemic control in type 2 diabetes. By inhibiting in a reversible way the hydrolysis of disaccharides and the ultimate steps of the digestion of dietary polysaccharides, alpha-glucosidase inhibitors reduce postprandial blood glucose mise in diabetics. This therapeutic class, limited in Europe until recently to acarbose, has been enlarged with the marketing of miglitol, whose pharmacokinetic properties might lead to better long term tolerance. The improvement of glycaemic control obtained with alpha-glucosidase inhibitors is now better evaluated and appears similar whatever the combinations with other antidiabetic drugs, including insulin. The role of alpha-glucosidase inhibitors in the overall therapeutic strategy of type 2 diabetes and their benefit on the evolution of long term complications remains to be clarified (C) 1999 Elsevier, Paris.