medwireNews: Men with recent-onset diabetes have twice the rate of erectile dysfunction as those without diabetes, but prevalence varies significantly among pathophysiology-based diabetes subgroups, German study findings indicate.
Christian Herder (German Diabetes Center, Düsseldorf) and team say that high rates among men with severe insulin-resistant diabetes and severe insulin-deficient diabetes “point to both insulin resistance and insulin deficiency as major contributing factors to this complication, suggesting different mechanisms underlying erectile dysfunction in these subgroups.”
They suggest that glucotoxicity may be a driver for erectile dysfunction in men with severe insulin-deficient diabetes, whereas lipotoxicity, oxidative stress, and low-grade inflammation, each related to insulin resistance, could contribute to erectile dysfunction in men with severe insulin-resistant diabetes.
The researchers report in Diabetologia that erectile dysfunction, assessed with the International Index of Erectile Function (IIEF)-5 questionnaire, was significantly more common in 351 men with recent-onset diabetes (<1 year) from the German Diabetes Study baseline cohort than in 124 men without diabetes, occurring at rates of 23% and 11%, respectively.
Among those with diabetes, prevalence was highest in men with severe insulin-resistant diabetes, at 52%, followed by those with severe insulin-deficient diabetes (31%), and mild age-related diabetes (29%). Men with mild obesity-related diabetes had a prevalence of 18%, while those with severe autoimmune diabetes had the lowest rate, at 7%.
Herder and team note that men with severe insulin-resistant diabetes had the lowest glycated hemoglobin levels in the study, which they say “indicates that glycaemic control may not be a major determinant of erectile dysfunction in adults with recent-onset diabetes.”
After adjustment for variables used to classify diabetes subgroups, high-sensitivity C-reactive protein levels, and depression, the investigators found that men with severe insulin-resistant diabetes were a significant 1.93 times more likely to have erectile dysfunction than men in the other four diabetes subgroups combined.
In addition, participants with severe insulin-deficient diabetes were a significant 3.27 times more likely to have erectile dysfunction than participants in the other groups together.
In unadjusted analyses, men with mild age-related diabetes also had a significantly higher risk for erectile dysfunction and those with severe autoimmune diabetes had a significantly lower risk, compared with the other groups, but these associations were attenuated in the adjusted analyses.
Herder et al conclude that “[t]he high prevalence of erectile dysfunction in [severe insulin-resistant diabetes] and [severe insulin-deficient diabetes] corroborates their high risk for diabetes-related complications and calls for comprehensive screening and early treatment in these subgroups.”
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