Drugs in this Class
Miglitol Tablets (Glyset Tablets)
Acarbose (Precose)

Summarizing the Evidence

• Currently there are no fully published head-to-head trials directly comparing Precose to Glyset. One partially published trial (published in summary form only) has shown the two medications to be similar in their ability to lower blood glucose levels after meals and in their ability to lower HbA1c levels (HbA1c or "hemoglobin - A1c" is a blood test that measures long-term diabetic control).

• Gastrointestinal (GI) side effects often limit the use of AGIs. Both AGIs can cause comparable GI side effects. Common GI side effects of both drugs include stomach pain, diarrhea, and flatulence or gas.

• The AGIs have the least overall effect on HbA1c levels compared to the other diabetic medications. The primary use for the AGIs is to lower blood sugar levels after eating. The AGIs have only a minimal effect on fasting blood sugar levels.

• While the AGIs are not the most effective class of diabetic medications, they do have some benefits. They typically do not cause low blood sugar symptoms that can occur with other diabetes medications. Also, they are not usually associated with weight gain (some of the other diabetes medications are associated with weight gain). By lowering blood sugar levels after meals, the AGIs may be useful in preventing development of diabetic complications and death due to heart-related disorders that have been associated with elevations in blood sugars after meals.

• Since the AGIs are similarly effective, the choice of which to use depends on your doctor's preference and/or your prescription benefits formulary.

Dosing and Administration

• Both Glyset and Precose are taken three times daily with the start (first bite) of each main meal. Dosages must be individualized based on effectiveness and tolerance of side effects. Both Glyset and Precose are typically started at the lowest possible dose and increased slowly over 1-2 months to minimize the GI side effects.

Generic Availability

• Acarbose (Precose) is the only alpha-glucosidase inhibitor currently available in generic formulations.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

1. AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. AACE diabetes mellitus guidelines. Glycemic management. Endocr Pract. 2007 May-Jun;13(Suppl 1):16-34.

2. Campbell LK, Baker DE, Campbell RK. Miglitol: assessment of its role in the treatment of patients with diabetes mellitus. Ann Pharmacother. 2000;34:1291-1301.

3. Chiasson JL, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance (The STOP-NIDDM Trial). JAMA. 2003;290(4):486-494.

4. Glyset [package insert]. Kalamazoo, MI: Pharmacia & Upjohn Company; October 2004.

5. Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M. Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J. 2004;25(1):10-16.

6. Hanefeld M, Temelkova-Kurktschiev T. Control of post-prandial hyperglycemia - an essential part of good diabetes treatment and prevention of cardiovascular complications. Nutr Metab Cardiovasc Dis. 2002;12:98-107.

7. Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes. Scientific review. JAMA. 2002;287(3):360-372.

8. Precose [package insert]. West Haven, CT: Bayer Corporation; November 2004.

9. Rybka J, Goke B, Sissmann J. European comparative study of alpha-glucosidase inhibitors, miglitol and acarbose [abstract]. Diabetes. 1998;48 Suppl 1:101.

10. Scott LJ, Spencer CM. Miglitol. A review of its therapeutic potential in type 2 diabetes mellitus. Drugs. 2000;59(3):521-549.

    Last Updated: October 2008

    Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

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