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Over 60% of Adults with Type 1 Diabetes Experience Sexual Dysfunction, Urologic Complications

Sep 22, 2018
 

Type 1 diabetes and sexual dysfunction: study shows at least one urologic complication was experienced during the course of seven years.

As the average person ages, urologic dysfunctions, such as incontinence and sexual dysfunction, increase in prevalence. For patients with diabetes, these complications can occur earlier and with more severity than a person without diabetes. It has been observed that men with diabetes are two to three times more likely to develop erectile dysfunction than those without diabetes, and around half of all men diagnosed with diabetes will develop erectile dysfunction within five to ten years of being diagnosed.

While numerous studies have indeed shown an association between diabetes and a high prevalence of urologic and sexual dysfunction, a new study aimed to quantify the burden of these complications in patients specifically with type 1 diabetes. Investigators of this study not only sought to determine the prevalence, but they also examined rates of emergence, persistence, and remission of both urologic dysfunctions in the chosen population.

The study examined two national surveys, the Urologic Epidemiology of Diabetes Interventions and Complications (UroEDIC) I and II, completed seven years apart. From these surveys, they assessed the prevalence of a multitude of urologic complications, which included difficulties, such as urinary incontinence (UI), urinary tract infections (UTI), lower urinary tract symptoms (LUTS), and sexual dysfunction.

A total of 508 women and 551 male participants were included in the analysis. Male sexual dysfunction was separated into erectile dysfunction (ED), sexual desire, and orgasmic dysfunction (OD) while sexual dysfunction in women was presented as a cumulative complication. UI was assessed based on the amount of urine lost, UTIs were assessed based on clinical diagnosis, and LUTS were analyzed based on individual categories, such as nocturia, urgency, weak urinary stream, straining, and sensation of incomplete emptying.

HbA1c was observed for both men and women both at baseline and throughout the surveys, as well as the presence of diabetic neuropathy and retinopathy.

Results of the study were given for prevalence of urologic and sexual dysfunctions over a 7-year period. 65% of women and 68% of men reported at least one urologic complication over the course of the study. Erectile dysfunction and female sexual dysfunction were the most prevalent among all complications, with 45% of men and 42% of women reporting those symptoms, respectively.

In regards to HbA1c, women who presented in the highest quartile range for HbA1c (>8.54%) showed two times greater likelihood of reporting LUTS compared to women in the lowest HbA1c quartile (<7.38%). Among male participants, those presenting in the highest quartile for HbA1c had a greater likelihood of reporting both ED and OD. Additionally, it was observed for men that those who presented with any type of diabetes-related microvascular complication were more likely to report LUTS, ED, and OD.

In total, over 65% of patients with type 1 diabetes included in the study presented with at least one urologic complication, indicating a substantial encumbrance on this patient population. Often times the more physically damaging complications, such as neuropathy and hypoglycemia, take precedence in diabetes management, but the results of this study may indicate a greater need for focus on urologic complications in order to better each patient’s quality of life. With over 30 million Americans who have  diabetes and a growing emphasis on quality of life, we may begin to see a shift in attention on management of diabetes-related complications.

Practice Pearls:

  • More than 65% of patients with type 1 diabetes presented with at least one urologic complication, including urinary incontinence, sexual dysfunction, and urinary tract infections.
  • Erectile dysfunction and female sexual dysfunction were the two most common urologic complications reported for both male and female participants, respectively.
  • Prevalence of urologic complications was positively correlated with higher HbA1c values.

Resources:

Wessells, H., Braffett, B. H., Holt, S. K., Jacobson, A. M., Kusek, J. W., Cowie, C., Sarma, A. V. (2018). Burden of Urological Complications in Men and Women With Long-standing Type 1 Diabetes in the Diabetes Control and Complication Trial/Epidemiology of Diabetes Interventions and Complications Cohort. Diabetes Care,41(9). doi:10.2337/dc18-0255

The Connection Between Type 2 Diabetes and ED. (2016, October). Retrieved from https://www.healthline.com/health/type-2-diabetes/type-2-and-erectile-dysfunction

Clarke Powell, Pharm.D. Candidate 2019, LECOM School of Pharmacy