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Authors Giugliano F, Maiorino M, Bellastella G, Gicchino M, Giugliano D and Esposito K.
Review Date Jun 2010
Citation N Engl J Med 2010;363:109-122
Men with diabetes have up to 3 times the rate of erectile dysfunction (ED) compared to men without diabetes, it occurs 10-15 years earlier, it is more severe and less responsive to oral treatment. There is disagreement about the role of glycaemic control in ED in men with diabetes which may be due to the range of comorbidities that men with diabetes have that are also associated with ED.
This Italian study was designed to evaluate the prevalence and correlates of ED in a population of diabetic men
Consecutive patients with type 2 diabetes were recruited among outpatients regularly attending Diabetes Clinics. Inclusion criteria for the initial selection of patients were a diagnosis of type 2 diabetes for at least 6 months but less than 10 years, aged 35-70 years, body mass index (BMI) of 24 or higher, HbA1c of 6.5% or higher. ED was assessed by the abbreviated IIEF-5 instrument (scores 1-21). Multiple logistic regression was used to assess correlates of ED. Odds Ratios are presented
A total of 555 (90.8%) of the 611 men who satisfied the selection criteria participated in the study. Mean age was 58 years (67% were aged 56 or older) and mean BMI 29.5 kg/m2. Approximately 6 in 10 men in the sample had varying degrees of erectile dysfunction: mild 9%, mild to moderate 11.2%, moderate 16.9% and severe 22.9%. The prevalence of severe ED increased with age with 29% or men aged 56-70 years having severe ED. 40% of men had sought medical advice for sexual difficulties and 32% had used PDE-5 inhibitors.
Higher haemoglobin A1c (HbA1c) levels were associated with ED (OR=1.18 per 1% HbA1c); similarly, the presence of metabolic syndrome (OR=2.08), hypertension (OR=1.34), atherogenic dyslipidaemia (low levels of HDL-cholesterol and high levels of triglycerides) (OR=1.23) and depression was associated with ED (OR=1.09). Physical activity was protective of ED; men with higher levels of physical activity were 10% less likely to have ED as compared with those with the lowest level. In conclusion, among subjects with type 2 diabetes glycaemic control and other metabolic covariates were associated with ED risk, whereas higher levels of physical activity were protective.
The results support the implementation of current medical guidelines that place intensive lifestyle changes as the first step of the management of type 2 diabetes.
Points to Note
- This is a cross-sectional observational study so caution is needed when interpreting the findings.
- The co-morbidities common in men with diabetes such as hypertension and dyslipidaemia were associated with ED independently of glycaemic control.
- Control of co-morbidities through lifestyle or other interventions may help to reduce the prevalence and/or incidence of ED in men with diabetes. However, this would need to be tested in intervention studies.