The Addition of Acarbose to Insulin Lispro Reduces Acute Glycaemic Responses in Patients with Type-2 Diabetes

This double-blind, placebo-controlled single-centre cross-over study assessed the efficacy of acarbose as adjunct to insulin lispro therapy in avoiding postprandial blood glucose rise. A total of 30 type 2 diabetic patients currently treated with insulin were included. On two consecutive days subjects received a standardised breakfast (covered by insulin lispro) and were randomly assigned study medication of either 100 mg acarbose or matching placebo. Basal and prandial insulin doses were maintained during the study period. A total of nine blood samples (for parameter assessment) were taken at 30-minute intervals. Primary efficacy variables were the difference in blood glucose rise from fasting to 90 min after breakfast between acarbose/lispro and lispro monotherapy and the difference in the postprandial glucose profile (area under the curve, 0 - 240 min). Secondary parameters consisted of differences in postprandial C-peptide, insulin and triglyceride time profiles between the two treatments. Acarbose treatment significantly reduced the rise in 90 min postprandial blood glucose (1.95 +/- 1.85 mmol/l) by more than half the increase observed under lispro monotherapy (4.37 +/- 2.13 mmol/l; p = 0.000). Postprandial blood glucose, C-peptide and serum insulin levels (AUC (0 - 240 min)) all significantly improved under acarbose treatment. Triglyceride levels were not affected by the combination therapy. Rapid-acting insulin lispro was efficiently complemented by the different mechanism of action of acarbose resulting in significant improvements of postprandial hyperglycaemia and the insulin profile.