Zimmermann Livia M, Baptista Mauricio S, Tardivo João Paulo, Pinhal Maria A
Faculdade de Medicina Do ABC, Santo André, Brazil.
Universidade de São Paulo, Department of Biochemistry, Chemistry Institute, São Paulo, Brazil.
Case Rep Med. 2020 May 9;2020:4065452. doi: 10.1155/2020/4065452. eCollection 2020.
Diabetes mellitus is a highly prevalent disease with rapid universal growth. In 2013, there were already 382 million people with diabetes, and it is expected that by 2035, this number will double. Chronic hyperglycemia causes a series of biochemical and structural changes, especially in the eyes, kidneys, heart, arteries, and peripheral nerves, which usually leads to the progression of microvascular disease. Several literature reports showed that the chronic use of phosphodiesterase-5 inhibitors enhances the insulin sensitivity, improves the markers of endothelial function, and helps in the treatment of severe extremity ischemia and pulmonary hypertension. We aim to test the effect of sildenafil citrate (SC) as a glucose and microcirculation regulator in diabetic patients, paying special attention to the consequences of its use in the regulation of blood glucose level. . Two male patients, aged 53 and 73 years, with type II diabetes, using oral hypoglycemic agents and presenting pathology associated with microcirculation alterations and ischemia, were medicated daily with SC. Both patients presented a reduction in the glycemic level, requiring lower doses or no other oral diabetes medications. Patient 1, who presented diabetic foot, was treated in the ambulatory, and patient 2, with chronic obstructive pulmonary disease and consequent mild pulmonary hypertension, was treated in the office. In addition to the clinical improvement of foot wounds and dyspnea due to the increase in microcirculatory perfusion, hypoglycemic episodes were observed in both patients under SC. The patient with pulmonary hypertension experienced one severe hypoglycemia episode and had to be taken to an emergency room.
Type 2 diabetic patients may benefit from the use of a phosphodiesterase-5 inhibitor in order to improve the microcirculatory perfusion as well as glycemic control. However, adverse side effects may involve hypoglycemia. Since off-label use of SC in patients suffering from microcirculatory alterations has increased recently, our results showed that more studies are needed to verify the prevalence of hypoglycemia episodes as well as it's possible physiologic mechanism.
糖尿病是一种普遍高发且迅速增长的疾病。2013年，全球已有3.82亿糖尿病患者，预计到2035年这一数字将翻倍。慢性高血糖会引发一系列生化和结构变化，尤其在眼睛、肾脏、心脏、动脉和周围神经，通常会导致微血管疾病的进展。一些文献报道显示，长期使用磷酸二酯酶-5抑制剂可增强胰岛素敏感性，改善内皮功能指标，并有助于治疗严重肢体缺血和肺动脉高压。我们旨在测试枸橼酸西地那非（SC）作为糖尿病患者血糖和微循环调节剂的效果，特别关注其在调节血糖水平方面的使用后果。两名男性患者，年龄分别为53岁和73岁，患有II型糖尿病，使用口服降糖药，伴有微循环改变和缺血相关病理状况，每日服用SC。两名患者的血糖水平均有所降低，所需口服降糖药剂量减少或不再需要其他口服降糖药。患者1患有糖尿病足，在门诊接受治疗；患者2患有慢性阻塞性肺疾病及由此导致的轻度肺动脉高压，在诊室接受治疗。除了因微循环灌注增加使足部伤口和呼吸困难在临床症状上有所改善外，两名服用SC的患者均出现了低血糖发作。患有肺动脉高压的患者经历了一次严重低血糖发作，不得不被送往急诊室。
2型糖尿病患者可能受益于使用磷酸二酯酶-5抑制剂来改善微循环灌注以及血糖控制。然而，不良副作用可能包括低血糖。由于最近SC在患有微循环改变的患者中存在超说明书用药的情况增加，我们的结果表明，需要更多研究来验证低血糖发作的发生率及其可能的生理机制。
