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Erectile Dysfunction Found as Significant Indicator for T2D Severity

Oct 23, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions

Sexual health questionnaires identifying erectile dysfunction can be used as an early detection tool for men’s CVD, coronary heart disease, stroke, and T2D.  

Discussions on sexual health are essential, considering that approximately 12-30% of males reported erectile dysfunction (ED) as their first symptom of T2D. Males with T2D might develop ED due to diabetes-associated microvascular changes, neuropathy, and endothelial dysfunction. Research suggests that ED is related to conditions such as hypertension, obesity, and heart disease. It may significantly increase the risk of CVD, coronary heart disease, stroke, and all-cause mortality. Therefore, the researchers of this study wanted to determine the prevalence of ED among men with T2D.  

 

This cross-sectional study from Nepal analyzed 160 male patients with T2D who frequented a diabetes outpatient center from January 2019 to December 2019. Inclusion criteria encompassed males with T2D who were in a stable relationship and had a history of hypertension. In addition, the study excluded participants that had a history of a psychiatric disorder, cardiovascular disease, renal disease, endocrinal disease, neurological disorder, and surgery. Patients with medications or chronic diseases that altered erectile function were also excluded. ED was assessed using a shortened version of the International Index of Erectile Function (IIEF-5) questionnaire. Individuals with an IIEF5 score <22 were classified as having ED. Collected data was imputed into Microsoft Excel, then transferred to IBM SPSS Statistics for analysis. The p-values were statistically significant if they were <0.05. The confidence interval was set at 95% (95% CI).  

The mean age was 45 years, and the mean IIEF5 score was 17.5. Most males in the study were nonsmokers (n=143) and did not consume any form of alcohol (n=134). The prevalence of ED among males with T2D was 77%, with severity ranging widely: normal (n=37), mild (n=61), mild-moderate (n=44), moderate (n=11), severe (n=7). There was a significantly higher presence of ED in individuals with a higher A1C (8.64% vs. 6.8%) and longer duration of T2D (4.9 years vs. 2.3 years) (p<0.05). There was no significant difference in ED among individuals with higher BMI (p=0.74) or higher waist circumference (p=0.54).  

The severity of ED was significantly associated with a prolonged history of T2D [<5 years (18.91± 4.05), 6-10 years (15.19 ± 4.29), >10 years (13.78 ± 5.26), (p<0.05). Patients with T2D and hypertension had a significant rise in severity of ED compared to individuals with T2D alone [T2DM (IIEF 18.23 ± 4.32), T2DM with hypertension (IIEF 15.36 ± 5.07), p <0.05]. The IIEF5 scores were slightly higher among active smokers when compared to nonsmokers. There was no significant association between erectile function and alcohol consumption (p-value 0.58).  

Previous studies found that up to 90% of patients with diabetes had erectile dysfunction, with numbers varying on geographic location: Ireland (59%), Pakistan (62.5%), Japan (64.6%), Slovak Republic (75%), China (59%), Japan (43%), Italy (19%). The prevalence of ED among Nepalese patients with T2D was 76.87%. The researchers believe cultural differences alongside the patient/doctor relationship might play a role in this disparity. Providing patient questionnaires increased the number of reported cases of ED in this population. However, patients were unwilling to come forward with their symptoms before being given the survey. This study highlighted the importance of comprehensive sexual health history and a physical exam for every male. This vital screening tool may be a quick and simple way for physicians to screen for cardiovascular health.   

Practice Pearls:  

  • The prevalence of erectile dysfunction among 160 males with T2D was 77%, with severity ranging greatly: normal function (n=37), mild (n=61), mild-moderate (n=44), moderate (n=11), severe (n=7). 
  • There was a significantly higher presence of erectile dysfunction in individuals with a higher A1C (8.64% vs. 6.8%) and a longer duration of T2D (4.9 years vs. 2.3 years). Conversely, there was no significant difference in erectile dysfunction among individuals with a higher BMI or higher waist circumference.  
  • Increased severity of erectile dysfunction was significantly associated with a prolonged history of T2D. In addition, patients with T2D and hypertension also saw a significant rise in severity of erectile dysfunction compared to individuals with T2D alone.  

 

Salonia A, Castagna G, Sacca A, Ferrari M, Capitanio U, Castiglione F, et al. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain. The journal of sexual medicine. 2012;9(10):2708-15 

Tamrakar D, Bhatt DS, Sharma VK, Poudyal AK, Yadav BK. Association Between Erectile Dysfunction and Type 2 Diabetes Mellitus. J Nepal Health Res Counc. 2021 Sep 6;19(2):378-383. doi: 10.33314/jnhrc.v19i2.3394. PMID: 34601534.  

 

Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions