Acarbose

Acarbose is an example of an alpha-glucosidase enzyme inhibitor used in the treatment of Type 2 diabetes. It is a complex oligosaccharide that acts as a competitive, reversible inhibitor of pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolase. (1)

Pancreatic alpha-amylase hydrolyses complex carbohydrates to oligosaccharides in the small intestine. Intestinal alpha-glucosidase hydrolase breaks down oligosaccharides, trisaccharides, and disaccharides (sucrose, maltose) to monosaccharides (glucose, fructose) in the brush border of the small intestine.

By delaying the digestion of carbohydrates, acarbose slows glucose absorption, reducing postprandial glucose blood concentrations.

Its use should be restricted to those who have failed to respond to diet alone and cannot tolerate conventional oral hypoglycaemic drugs, or in whom the latter class are contraindicated.

Note - acarbose is now used infrequently following the advent of drugs such as SGLT-2 inhibitors, DPP-4 inhibitors and GLP-1 receptor agonists.(2)

Reference

1. Altay M. Acarbose is again on the stage. World J Diabetes. 2022 Jan 15;13(1):1-4
2. NICE. Type 2 diabetes in adults: management. NICE guideline NG28. Published December 2015, last updated February 2026