An inexpensive oral medication acting inside the gut, slowing starch and table sugar digestion so blood sugar rises more gently after eating. Human evidence is strong for flatter after-meal blood sugar and delayed progression to diabetes, not for preventing heart attacks and strokes. Life extension seen in mice has never been tested in humans. Gas and loose stools are common. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Two-hour post-meal glucose | < 120 mg/dL | The variable acarbose directly targets |
| Continuous glucose monitor peak excursion | Rise of < 30 mg/dL above pre-meal value | Most sensitive index of whether the drug works |
| Hemoglobin A1c | 4.9–5.4% | Integrates average glucose over roughly 3 months |
| Fasting insulin | 2–6 µIU/mL | Detects insulin resistance before glucose rises |
| HOMA-IR | < 1.5 | Calculated index of insulin resistance |
| ALT | 10–26 U/L (men), 8–22 U/L (women) | Detects the drug's dose-dependent liver effect |
| AST | 10–26 U/L | Paired with ALT to characterize any liver signal |
| Creatinine and eGFR | eGFR > 60 mL/min/1.73 m² | Sets the safety ceiling; absorbed fraction is renally cleared |
| Triglycerides | < 80 mg/dL | One of the two lipid markers acarbose measurably moves |
| hs-CRP | < 0.5 mg/L | Tracks systemic inflammation |
| Ferritin | 50–150 ng/mL | Tracks iron status alongside small hematocrit reductions |
| Vitamin B12 | 500–900 pg/mL | Screens for malabsorption on long-term gut-active therapy |
Cadence: Liver enzymes at 3, 6, 9 and 12 months, then annually; hemoglobin A1c, fasting insulin and lipids at 3 months, then every 6–12 months; ferritin and complete blood count annually; two-week continuous glucose monitoring at 3 months, then annually; weight, and grip strength above 65, at every check.