Poolsup Nalinee, Suksomboon Naeti, Aung Nandar
Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand.
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand.
J Clin Transl Endocrinol. 2016 Nov 25;6:50-55. doi: 10.1016/j.jcte.2016.11.003. eCollection 2016 Dec.
Chronic use of phosphodiesterase-5 inhibitors (PDE-5i) has been shown to improve insulin action on muscle glucose uptake by the prolongation of nitric oxide (NO)/cyclic guanosine monophosphate (cGMP)/protein kinase (PKG) signalling.
As the effects of PDE-5i on glycemic control in person with type 2 diabetes mellitus (T2DM) have not been systematically explored, we conducted a meta-analysis of available randomized controlled trials (RCTs).
A literature search was performed through electronic databases including MEDLINE (Pubmed), The Cochrane Library, SCOPUS, Web of Science, CINAHL, www.clinicaltrials.gov and www.clinicaltrialresults.org until April 2016 without language restriction. Studies were included if they met the following criteria: (i) RCTs of the chronic use of PDE-5i compared with placebo or no active treatment in T2DM patients (ii) reporting of HbA1c or glycated haemoglobin or fasting plasma glucose (FPG).
Four studies involving a total of 198 patients fit into the inclusion criteria. All included studies used the same PDE-5i, sildenafil. Reports of HbA1c were analysed as only one study reported FPG. PDE-5i had no beneficial effect on HbA1c with weighted mean difference (WMD) of 0.17% (95% CI, -0.64 to 0.97).
This meta-analysis suggests that large and well-controlled studies are warranted to shed light on the effect of PDE-5i on glycemic control in people with type 2 diabetes mellitus.
长期使用磷酸二酯酶-5抑制剂（PDE-5i）已被证明可通过延长一氧化氮（NO）/环磷酸鸟苷（cGMP）/蛋白激酶（PKG）信号通路来改善胰岛素对肌肉葡萄糖摄取的作用。
由于尚未系统探讨PDE-5i对2型糖尿病（T2DM）患者血糖控制的影响，我们对现有的随机对照试验（RCT）进行了荟萃分析。
通过电子数据库进行文献检索，包括MEDLINE（PubMed）、Cochrane图书馆、SCOPUS、科学网、CINAHL、www.clinicaltrials.gov和www.clinicaltrialresults.org，检索截至2016年4月的文献，无语言限制。符合以下标准的研究被纳入：（i）T2DM患者中PDE-5i长期使用与安慰剂或无活性治疗的RCT；（ii）报告糖化血红蛋白（HbA1c）或糖化血红蛋白或空腹血糖（FPG）。
四项共涉及198例患者的研究符合纳入标准。所有纳入研究均使用相同的PDE-5i西地那非。由于只有一项研究报告了FPG，因此对HbA1c的报告进行了分析。PDE-5i对HbA1c无有益影响，加权平均差（WMD）为0.17%（95%CI，-0.64至0.97）。
这项荟萃分析表明，有必要进行大规模且严格对照的研究，以阐明PDE-5i对2型糖尿病患者血糖控制的影响。
