GAA and obesity due to melanocortin 4 receptor deficiency: However, miglitol, unlike acarbose, has some bioavailability; thus, it may reach peripheral tissues (Ahr et al., 1997) and has many positive effects in the setting of obesity and diabetes, including increasing glycemic control (Goda et al., 2007), energy expenditure (Sugimoto et al., 2014), and reducing obesity and fatty liver disease (Kishida et al., 2017; Komatsu et al., 2018), possibly due to effects of GAA inhibition in peripheral tissues, although this is not fully established.