Inclusion Criteria:  Hemoglobin A1C between 5.7 and 6.4 Body mass index between 27 and 45  Exclusion Criteria:  Diabetes Chronic use of any antidiabetic medications Any unstable medical condition Use of steroids or daily use of NSAIDS History of chronic inflammatory conditions Use of anticoagulants Contraindications to the use of mirabegron or tadalafil Any condition deemed risky by the study physician