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Sildenafil Improves Insulin Sensitivity in Prediabetes

Decrease in plasminogen activator inhibitor-1 without affecting tissue-plasminogen activator

WEDNESDAY, Nov. 18, 2015 (HealthDay News) — For patients with prediabetes, three-month sildenafil treatment improves insulin sensitivity, according to a study published online Nov. 18 in the Journal of Clinical Endocrinology & Metabolism.

Claudia E. Ramirez, M.D., from the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues examined whether chronic phosphodiesterase 5 inhibition with sildenafil improves insulin sensitivity and secretion without diminishing fibrinolytic function in a randomized, double-blind trial. Overweight individuals with prediabetes were randomized to treatment with sildenafil or matching placebo for three months (21 subjects in each arm). Before and after treatment, subjects underwent a hyperglycemic clamp.

The researchers found that after adjustment for baseline insulin sensitivity index and body mass index, the insulin sensitivity index was significantly greater in the sildenafil versus placebo group after three months (P = 0.049). Three-month treatment with sildenafil had no effect on acute- or late-phase glucose-stimulated insulin secretion (P > 0.30). Sildenafil treatment correlated with a decrease in plasminogen activator inhibitor-1 (P = 0.01), with no alteration of tissue-plasminogen activator. Sildenafil also reduced the urine albumin-to-creatinine ratio, in contrast to placebo; this effect persisted for three months after discontinuation of sildenafil.

“Three-month phosphodiesterase 5 inhibition enhances insulin sensitivity and improves markers of endothelial function,” the authors write.

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