Endocrine Abstracts

Postprandial hypotension (PPH) is common for older adults and may lead to syncope and falls. Adults with autonomic dysfunction, commonly those with diabetes mellitus (DM), are also at risk for PPH. Reported prevalence rates are 40% for PPH in DM patients. To date there are no reliable treatments for this condition in DM patients. It was our objective to demonstrate Acarbose, an α-glucosidase inhibitor, decreases the degree of PPH in an elderly DM cohort.

Fifteen adults (nine women and six men) with average age of 75.9 years (range: 67–85.2), BMI of 28.6 kg/m² (range: 20.1–35.5), and individual history of DM type 2 (duration: 9.0 years; hemoglobin A1C 6.8%) attended a treatment and placebo session (separate days at least 2 weeks apart) in random double-blinded order. Subjects were fed a standardized meal (4 °C) and then continuously monitored over 90 min for blood pressure by finometry, heart rate by electrocardiogram, and middle cerebral artery blood flow velocity by transcranial Doppler ultrasound (20-min baseline recorded for all measurements). Intravenous cannula was placed for blood glucose and catecholamine measurements.

Prevalence of PPH was 86.7% in DM subjects (n=13/15). The frequency of PPH occurring per study was 1.22 (range: 1–3) for Acarbose and 1.75 (range: 1–3) for placebo, and this difference was significant (t-test, P=0.0359). The hemodynamic response of systolic blood pressure (SBP) and mean arterial pressure (MAP) (baseline as covariant) was significantly different for subjects given Acarbose by mixed-model repeated measures two-factor (time and treatment) analysis of variance (SBP: P=0.0248, see figure; MAP: P=0.0499).

The reported higher prevalence of PPH in our study warrants further investigation. This is the first study to demonstrate Acarbose attenuates PPH in adults with DM. Our results suggest that Acarbose is a potential therapy for PPH in older adults with DM type 2.