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“Key Points Switching α-glucosidase inhibitors to miglitol reduced glucose fluctuations and circulating cardiovascular disease (CVD) risk factors in type 2 diabetic Japanese patients Reducing glucose fluctuations may reduce the development of CVD in type 2 diabetic patients 1 Introduction Large-scale cohort studies such as Diabetes Epidemiology: Collaborative else analysis of Diagnostic criteria in Europe (DECODE) and FUNAGATA have shown that impaired glucose tolerance (IGT) is strongly associated with subsequent incidence of cardiovascular disease (CVD) [1–3]. The Study TO Prevent Non-insulin-dependent diabetes mellitus (STOP-NIDDM) and Meta-analysis of Risk Improvement under Acarbose (MeRIA7) trials have demonstrated that inhibition of postprandial hyperglycemia by the α-glucosidase inhibitor (α-GI) acarbose reduces pronounced CVD events in subjects with IGT and type 2 diabetes [4, 5]. These results suggest that inhibition of postprandial hyperglycemia, rather than the total rise of glucose throughout the day, in type 2 diabetic patients is important for preventing CVD development.