An α-glucosidase inhibitor, such as acarbose, reduces the risk of IGT progressing to type 2 diabetes mellitus (T2DM), and it prevented the development of cardiovascular disease in the STOP-NIDDM trial. Here, we compared the effects of acarbose and voglibose monotherapy on GLP-1 secretion and postprandial dyslipidemia in patients with T2DM. 
The study enrolled Japanese patients who had T2DM with HbA1c levels ≤ 7.4% who were not taking any antihyperglycemic agents. The 30 patients (51.2±11.5 years, HbA1c 6.3±0.6%) were randomized to 300 mg acarbose (n = 15) or 0.3 mg voglibose (n = 15). All patients had a meal tolerance test (MTT) performed before and after 12 weeks of treatment. Twelve weeks after treatment, HbA1c decreased by 0.09±0.26% with acarbose and 0.05±0.61% with voglibose, and the difference was not significant. Triglyceride (TG) decreased by 17.7% with acarbose (P < 0.02) and increased by 5.5 % with voglibose (NS). The delta active GLP-1, defined as the difference between the peak and baseline, was +6.6% (NS) with acarbose and +116.5% with voglibose (P < 0.05). Comparing the change in the incremental area under the MTT curves (AUC) for GLP-1 and lipids from baseline to 12 weeks of treatment, the AUC for active GLP-1 decreased by 6.1% with acrabose whereas it increased by 19.6% with voglibose, and the difference was significant (P < 0.05). In comparison, the AUC for TG and RLP-C decreased by 13% and 6.5% respectively, with acarbose, whereas they increased by 3.5% and 8.3% respectively, with voglibose, and the difference was significant (P < 0.05, respectively). 
In conclusion, the treatment of T2DM with voglibose resulted in a greater increase in active GLP-1 levels during the MMT than with acarbose, while acarbose significantly reduced the postprandial TG and RLP-C levels. Therefore, voglibose enhances GLP-1 secretion, whereas acarbose improves postprandial dyslipidemia in patients with T2DM.

Comparison of acarbose versus voglibose monotherapy on GLP-1 secretion and dyslipidemia in type 2 diabetes patients