Early Detection of Erectile Dysfunction in Men with Type 2 Diabetes

Erectile Dysfunction

Erectile dysfunction (ED) is defined as the persistent or recurrent inability to achieve or maintain an erection adequate for satisfactory sexual intercourse. It is a common complication of type 2 diabetes (T2DM). Its prevalence in men with T2DM is 1.9–4 times higher than in non-diabetics, and it typically develops 10–15 years earlier as a result of endothelial dysfunction and vascular damage induced by hyperglycemia.

Given its adverse impact on family life and patient quality of life, early diagnosis and treatment are essential to prevent ED progression. In 2021, the results of a retrospective study aimed at identifying risk factors for ED in T2DM, including threshold values for its early detection, were published.

Study Methodology

The retrospective cohort included 105 patients with T2DM and ED examined between May 2019 and April 2020, and 105 age-matched patients with T2DM without ED. The presence of ED was assessed using the International Index of Erectile Function-5 questionnaire. Potential risk factors for ED were compared between the groups.

Results

The average age of the patients was 44 years, and the average BMI was 25 kg/m². There were no significant differences between the ED and non-ED groups in terms of age, BMI, presence of hypertension and coronary artery disease, smoking, blood pressure, fasting glucose levels, insulin levels, glycated hemoglobin (HbA_1c), lipid levels, or family history of T2DM. Compared to patients without ED, those with ED had a significantly higher incidence of diabetic peripheral neuropathy (37.1% vs. 23.8%; p = 0.035) and retinopathy (32.4% vs. 8.6%; p < 0.001), longer diabetes duration (p < 0.001), lower eGFR (p = 0.010), and higher levels of uric acid (p < 0.001) and C-reactive protein (CRP; p = 0.001).

Multivariate regression analysis identified uric acid levels, the presence of diabetic retinopathy, and T2DM duration as independent predictors of ED. The presence of diabetic retinopathy tripled the risk of ED, T2DM duration of 49 months increased the risk nearly fourfold, and uric acid levels ≥ 392.5 μmol/l increased the risk nearly nineteenfold compared to normal range values.

Conclusion

The authors conclude that in patients with T2DM, reliable predictors of ED include higher levels of uric acid (≥ 392.5 μmol/l), longer diabetes duration (≥ 49 months), and the presence of diabetic retinopathy. Careful screening and early treatment are essential for patients with T2DM who have these ED risk factors.

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Source: Fan J., Peng T., Hui J. et al. Erectile dysfunction in type-2 diabetes mellitus patients: predictors of early detection and treatment. Urol Int 2021; 105 (11–12): 986–992, doi: 10.1159/000514700.