Potential of alpha-glucosidase inhibitors in elderly patients with diabetes mellitus and impaired glucose tolerance.

The prevalence of diabetes mellitus (DM) among the elderly, who constitute > 20% of the population in developed countries, is high (up to 40%). Indeed, elderly people represent the bulk (approximately 50%) of the diabetic population. There is much evidence that better glycaemic control can reduce the morbidity associated with this disease. alpha-Glucosidase inhibitors are well tolerated in the treatment of DM in this population. They reduce postprandial hyperglycaemia and have a moderate effect on fastign plasma glucose levels, resulting in a significant reduction in glycated haemoglobin (HbA1C) levels. alpha-Glucosidase inhibitors can be used either as monotherapy or in combination with other oral hypoglycaemic agents or insulin. The good safety profile of these drugs makes them suitable for use in elderly patients with type 2 (non-insulin-dependent) DM, because they can achieve substantial metabolic improvements without any additional risks. Thus, the use of alpha-glucosidase inhibitors should be considered: (i) as a first-choice treatment in newly diagnosed patients; (ii) in individuals whose DM is not well controlled with any other type of treatment; (iii) as an alternative to sulphonylureas or biguanides in patients at risk from hypoglycaemia or lactic acidosis, respectively. Despite the numerous potential advantages of alpha-glucosidase inhibitors in elderly patients with type 2 DM, there is a lack of studies focusing specifically on that population. However, such studies are under way. In addition, the potential of alpha-glucosidase inhibitors in the prevention of type 2 DM and/or on macrovascular disease is currently under study.