How to Prevent Sexual Dysfunctions due to Diabetes?

Review Author

Dr. Ashok Koparday

How does Diabetes affect Sexual Function?

Diabetes, a widely prevalent metabolic disorder, amongst other organ systems of the human body also affects male and the female sexual organs. Diabetic neuropathy (= damage to the nerves) and angiopathy (=damage to the blood vessels) cause sexual dysfunctions in men and women.
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How common is Diabetic Neuropathy?

6 to 7 people out of 10 people with Diabetes have Diabetic Neuropathy in the United States ^[1].

Review of Epalrestat

Epalrestat, new medicine to prevent Diabetic Neuropathy, brings hope in the prevention and treatment of Erectile Dysfunctions in people with Diabetes Mellitus. (Diabetes Type II).
At present treatment options for Diabetic Neuropathy include

• antidepressants,
• anticonvulsants,
• tramadol, and
• capsaicin.

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Research study Epalrestat

Data from six clinical trials were evaluated, and it was determined that epalrestat may improve motor and sensory nerve conduction velocity and subjective neuropathy symptoms as compared with baseline and placebo. ^[3]

What is the dose of Epalrestat?

50 mg 3 times/day

Side effects of Epalrestat:

Most frequent

• elevations in liver enzyme levels
• nausea and vomiting.

“Long-term treatment with epalrestat is well tolerated and can effectively delay the progression of diabetic neuropathy and ameliorate the associated symptoms of the disease, particularly in subjects with good glycemic control and limited microangiopathy,”^[2]

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How does Epalrestat act?

An enhanced polyol pathway within the central nervous system is part of the etiology of neuropathy among diabetic patients,
Epalrestat is an aldose reductase inhibitor
Data from experimental studies indicate that epalrestat reduces sorbitol accumulation in the sciatic nerve, erythrocytes, and ocular tissues in animals, and in erythrocytes in humans.
Epalrestat improves motor and sensory nerve conduction velocity and subjective neuropathy symptoms.
“As aldose reductase is a key enzyme of the polyol pathway, aldose reductase inhibitors (ARIs) have received much attention worldwide…. Epalrestat is easily absorbed into neural tissue and potently inhibits aldose reductase with minimum adverse effects.”[4]
Epalrestat may serve as a new therapeutic option to prevent or slow the progression of diabetic neuropathy. Long-term, comparative studies in diverse patient populations are needed for clinical application.
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CONLCUSION

Take home message

Long term treatment with Epalrestat may delay symptoms caused by diabetic neuropathy in people who have well controlled blood glucose level (tight glycemic control) ^[6]

[1]1: Pharmacotherapy. 2008 May;28(5):646-55.
Ramirez MA, Borja NL.
Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida, USA.
[2] Diabetes Care. 2006;29:1538-1544

[3]http://www.ncbi.nlm.nih.gov/pubmed/18447661
[4] Nigishi Hotta, MD, PhD, from Chubu Rosai Hospital in Nagoya, Japan, and colleagues from the Aldose Reductase Inhibitor-Diabetes Complications Trial (ADCT) Study Group.
[5]
[6] http://www.diabetes.org/diabetes-research/summaries/Hotta-Epalrestat-Delays-Nerve-Damage.jsp

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The material presented here does not necessarily reflect the views of Samadhan India: Center for Therapy, Education, Research in Sex, Marrriage and Relationships or its educational websites

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Further Reading
http://www.akademiai.com/content/v1m67g2122636k68/