MON-556 - Impact of Acarbose Addition to on Postprandial Glucose and Prandial Insulin Dosages in Type 1 Diabetes

Introduction:
Postprandial hyperglycemia, a common problem in type 1 diabetes patients leads to higher insulin requirements. Even with insulin, achieving glycemic control remains difficult. Adding Acarbose, an alpha-glucosidase inhibitor, may decrease postprandial spikes and decrease insulin doses.
Aim and

Objective:
To evaluate the effect of Acarbose as an add-on therapy on postprandial glucose and insulin dose requirements in adults with T1DM.
Materials and

Methods:
This prospective 12-week interventional study included adults with T1DM on stable insulin therapy. A formal sample size calculation was not conducted since this study is exploratory. Instead, a sample size of 20 participants was chosen based on feasibility and anticipated patient compliance with acarbose therapy and follow-up. Of 20 participants, only 14 completed the study. Baseline FPG (fasting plasma glucose), PPPG (postprandial plasma glucose), HbA1c, total daily insulin dose (basal and bolus components), body weight, and BMI (Body Mass Index) were checked before starting Acarbose. Participants were started on Acarbose 50 mg once daily, taken before breakfast, and added to their existing insulin therapy and gradually up-titrated to three times daily and continued for 12 weeks. All parameters were reassessed at the end of 12 weeks. Pre- and post-intervention values were compared using paired statistical analysis.

Results:
Acarbose add-on therapy resulted in significant improvement in postprandial glycemia with a reduction in insulin requirements, without adverse effects on weight
Conventional glycemic parameters:
FBG decreased marginally from 161.00 ± 30.14 to 159.21 ± 30.33 mg/dL (p = 0.58; NS) but was not statistically significant, PPBG decreased significantly from 214.21 ± 26.96 to 201.43 ± 25.18 mg/dL (p = 0.001) which was statistically significant, HbA1c decreased from 10.48 ± 0.89% to 10.28 ± 0.98% (p = 0.12; NS) which was statistically non-significant but showed a positive trend.
Anthropometric parameters:
Body weight decreased from 66.44 ± 13.25 to 65.49 ± 13.32 kg (p = 0.02), which was not statistically significant but may be related to a decrease in insulin doses. BMI decreased from 24.06 ± 2.89 to 23.73 ± 3.01 kg/m² ( p = 0.01).
Insulin requirements: Basal insulin dose was increased but did not reach statistical significance (23.29 ± 3.99 → 23.64 ± 3.94 units; +1.5%, p = 0.40), Bolus insulin dose decreased from 37.21 ± 5.63 to 34.36 ± 4.57 units (p = 0.005), reaching statistical significance. Total daily insulin dose decreased from 60.50 ± 7.12 to 58.00 ± 6.18 units (p = 0.006).
Discussion and

Conclusion:
Addition of acarbose resulted in significant blunting of postprandial glucose excursions and despite a reduction in the bolus insulin dosages making it an alternative adjunct in type 1 DM
Keywords: Acarbose, Type 1 Diabetes, Postprandial Blood Glucose, HbA1c

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