Proton pump inhibitors and nitric oxide mechanisms in type 2 diabetes

Excerpt

To the Editor: Hove et al carried out an interesting randomised prospective placebo-controlled study to examine the effects of esomeprazole, a proton pump inhibitor (PPI) on insulin secretion, HbA_1c and risk factors for cardiovascular disease in patients with type 2 diabetes [1]. In contrast with their initial hypothesis, they found that treatment with the PPI did not improve insulin secretion or glycaemic control in patients with type 2 diabetes. Curiously, they reported that daytime systolic blood pressure and 24 h diastolic blood pressure tended to increase in patients treated with esomeprazole. While the authors try to explain their apparently unexpected findings, there is now recent evidence strongly suggesting new mechanisms involving the potent vasodilator NO [2], which may help to clarify their findings. …