maltitol and Diabetes-Mellitus--Type-2

This study investigated the effects of maltitol on intestinal glucose absorption and muscle glucose uptake using ex vivo and in vivo experimental models. The ex vivo experiment was conducted in isolated jejunum and psoas muscle from normal rats. The in vivo study investigated the effects of a single bolus dose of maltitol on gastric emptying, intestinal glucose absorption and digesta transit in normal and type 2 diabetic rats. Maltitol inhibited glucose absorption in isolated rat jejunum and increased glucose uptake in isolated rat psoas muscle in the presence of insulin but not in the absence of insulin. In contrast, maltitol did not significantly (p > 0.05) alter small intestinal glucose absorption or blood glucose levels as well as gastric emptying and digesta transit in normal or type 2 diabetic rats. The results suggest that maltitol may not be a suitable dietary supplement for anti-diabetic food and food products to improve glycemic control.

Topics: Absorption, Physiological; Animals; Diabetes Mellitus, Type 2; Dietary Supplements; Disease Models, Animal; Gastric Emptying; Gastrointestinal Agents; Gastrointestinal Transit; Glucose; Hyperglycemia; Hypoglycemic Agents; In Vitro Techniques; Insulin; Intestinal Absorption; Intestinal Mucosa; Jejunum; Male; Maltose; Muscle, Skeletal; Psoas Muscles; Random Allocation; Rats, Sprague-Dawley; Sugar Alcohols

The poorly water soluble antidiabetic drug gliclazide was selected to study the effect of excipients on dissolution rate enhancement. Ordered mixtures of micronized gliclazide with lactose, mannitol, sorbitol, maltitol and sodium chloride were prepared by manual shaking of glass vials containing the drug and excipient(s). Different water soluble excipients, addition of surfactant and superdisintegrant, drug concentration and carrier particle size influenced the dissolution rate of the drug. Dissolution rate studies of the prepared ordered mixtures revealed an increase in drug dissolution with all water soluble excipients. The order of dissolution rate improvement for gliclazide was mannitol > lactose > maltitol > sorbitol > sodium chloride. Composite granules of the particle size range 355-710 μm were superior in increasing the drug dissolution rate from ordered mixtures. Reducing the carrier particle size decreased the dissolution rate of the drug as well as the increase in drug concentration. Kinetic modeling of drug release data fitted best the Hixson-Crowell model, which indicates that all the ordered mixture formulations followed the cube root law fairly well.

Topics: Diabetes Mellitus, Type 2; Drug Carriers; Drug Compounding; Drug Delivery Systems; Excipients; Gliclazide; Humans; Hypoglycemic Agents; Lactose; Maltose; Models, Theoretical; Particle Size; Pharmacokinetics; Sodium Dodecyl Sulfate; Solubility; Starch; Sugar Alcohols; Surface-Active Agents; Suspensions; Water

An 87-year-old woman, diagnosed with diabetes mellitus at age 73, exhibited abdominal distention and appetite loss in March 1998. She had received acarbose as well as 5 mg per day of glibenclamide and had habitually used about 100 g of maltitol daily from 1997. She was diagnosed as having paralytic ileus accompanied by pneumatosis cystoides intestinalis (PCI). This condition subsided quickly with discontinuation of diet or cessation of acarbose and maltitol usage. The patient's condition appears to be attributable to increased gas levels produced by fermentation of disaccharides and maltitol. Decreased intestinal motility may be a result of pre-existing diabetic autonomic neuropathy and hypothyroidism. The patient's clinical course suggests that paralytic ileus and PCI should be listed as rare side effects of alpha-glucosidase inhibitors and that the drug should be used with great caution for those who consume non-digestive sugar substitutes.

Topics: Acarbose; Aged; Aged, 80 and over; Diabetes Mellitus, Type 2; Enzyme Inhibitors; Female; Humans; Hypoglycemic Agents; Intestinal Pseudo-Obstruction; Maltose; Pneumatosis Cystoides Intestinalis; Sugar Alcohols; Sweetening Agents; Tomography, X-Ray Computed