Hepatic encephalopathy in cirrhosis is contributed to by toxic products deriving from the proteolytic bacterial flora–related degradation of dietary nitrogen substances.
Acarbose is a novel hypoglycemic agent acting through the inhibition of glucose absorption in the gut and the promotion of intestinal saccharolytic bacterial flora at the expense of proteolytic flora.
Dr Gentile and colleagues from Naples, Italy undertook a study in order to assess whether acarbose exerts a beneficial effect on hepatic encephalopathy and on postprandial hyperglycemia.
The researchers included cirrhotic patients with low-grade hepatic encephalopathy and type 2 diabetes mellitus in the study.
In total, the research team randomized 107 cirrhotic patients with grade 1–2 hepatic encephalopathy and type 2 diabetes mellitus to acarbose 100 mg 3 times daily or placebo for 8 weeks.
The researchers then switched the patients treatments after a 2-week washout period and patients were then followed for 8 more weeks.
|Acarbose significantly decreased ammonia blood levels and improved Reitan’s test score|
|Clinical Gastroenterology and Hepatology|
The team determined ammonia blood levels, Reitan’s number connection test, intellectual function, fasting and postprandial glucose levels, glycated hemoglobin values, and C peptide values.
The investigators recorded these values at 2 weeks before and then 4, 8, 11, 14, and 18 weeks after treatment.
The researchers found that acarbose significantly decreased ammonia blood levels and improved Reitan’s test score and intellectual function score compared with placebo.
In addition, the team noted that acarbose caused a 33% decrease in fasting glucose level and an approximately 50% decrease in postprandial glucose level compared with placebo.
Acarbose significantly lowered glycated hemoglobin values and postprandial C peptide compared with baseline values, whereas placebo did not.
The research team found that there was no change in biochemical parameters of liver function after acarbose treatment.