Delaying carbohydrate absorption in noninsulin-dependent diabetes mellitus: useful therapy?

Epidemiological and psychological studies have revealed major difficulties in motivating diabetic patients to observe a long-term dietary regimen. Therefore, manipulation of intestinal digestion or absorption appears to be a feasible therapeutic approach in the management of diabetes. The addition of natural or chemically processed fiber has been shown to decrease both the postprandial and fasting blood glucose in type-2 diabetics by delaying carbohydrate absorption. Recently, selective enzyme inhibitors of glycoside hydrolases in the upper intestine have been found which create a moderate degree of malabsorption of carbohydrates. The postprandial blood sugar response can be reduced by 50%. However, both these forms of treatment may not be accepted by patients because of impalatability or gastrointestinal side effects. At present only short-term studies with each group of substances are available. Whether the reduction of hyperglycemia is sufficient for the prevention of complications must be clarified in long-term trials.