Use of acarbose for eliminating the interval between meal consumption and insulin injection in patients with Type 1 diabetes.

This double-blind, placebo-controlled, cross-over study investigated whether acarbose therapy enables patients with Type 1 diabetes to administer insulin injections at the same time as meals without adverse glycaemic consequences, thus negating the need for an injection-meal interval (IMI). The valid-case population was 15. All patients were well controlled on insulin therapy and diet. Each patient underwent four 14-d treatment sequences: IMI of 0 min+acarbose; IMI of 30 min + acarbose; IMI of 0 min + placebo; IMI of 30 min + placebo. There was a 1-wk, placebo-controlled washout period between each treatment. A 50 mg acarbose or placebo tablet was taken with each of three meals for the first 3 d of each treatment; this was increased to 100 mg three times daily on the remaining 11 d. Blood samples were taken between 08.00 and 09.00 h at the end of each treatment sequence, during the fasting state and at the following times after breakfast: 30, 60, 120 and 180 min. The primary target variable was 1-hr postprandial blood glucose level after 14 d. The mean increase in 1-hr postprandial blood glucose level using an IMI of 0 min + acarbose was 51.1+/-53.2 mg/dl, compared with 46.6+/-50.4 mg/dl using a 30-min IMI + placebo. Data provided strong evidence that acarbose prevents the marked increase in postprandial glucose level normally observed when insulin is administered with a meal. Acarbose may thus be useful for patients with Type 1 diabetes who find IMIs inconvenient.