Differences in the prevalence of erectile dysfunction between novel subgroups of recent-onset diabetes

Gds Group ,Christian Herder,Michael Roden,Klaus Strassburger,Haifa Maalmi,Julia Szendroedi,Wolfgang Rathmann,Oana-Patricia Zaharia,Gidon J Bönhof,Dan Ziegler,Volker Burkart

doi:10.1007/s00125-021-05607-z

Abstract

Aims/hypothesisIn men with diabetes, the prevalence of erectile dysfunction increases with advanced age and longer diabetes duration and is substantially higher in men with type 2 diabetes than those with type 1 diabetes. This study aimed to evaluate the prevalence of erectile dysfunction among the five novel subgroups of recent-onset diabetes and determine the strength of associations between diabetes subgroups and erectile dysfunction.MethodsA total of 351 men with recent-onset diabetes (<1 year) from the German Diabetes Study baseline cohort and 124 men without diabetes were included in this cross-sectional study. Erectile dysfunction was assessed with the International Index of Erectile Function (IIEF) questionnaire. Poisson regression models were used to estimate associations between diabetes subgroups (each subgroup tested against the four other subgroups as reference) and erectile dysfunction (dependent binary variable), adjusting for variables used to define diabetes subgroups, high-sensitivity C-reactive protein and depression.ResultsThe prevalence of erectile dysfunction was markedly higher in men with diabetes than in men without diabetes (23% vs 11%, p = 0.004). Among men with diabetes, the prevalence of erectile dysfunction was highest in men with severe insulin-resistant diabetes (SIRD) (52%), lowest in men with severe autoimmune diabetes (SAID) (7%), and intermediate in men with severe insulin-deficient diabetes (SIDD), mild obesity-related diabetes (MOD) and mild age-related diabetes (MARD) (31%, 18% and 29%, respectively). Men with SIRD had an adjusted RR of 1.93 (95% CI 1.04, 3.58) for prevalent erectile dysfunction (p = 0.038). Similarly, men with SIDD had an adjusted RR of 3.27 (95% CI 1.18, 9.10) (p = 0.023). In contrast, men with SAID and those with MARD had unadjusted RRs of 0.26 (95% CI 0.11, 0.58) (p = 0.001) and 1.52 (95% CI 1.04, 2.22) (p = 0.027), respectively. However, these associations did not remain statistically significant after adjustment.Conclusions/interpretationThe high RRs for erectile dysfunction in men with recent-onset SIRD and SIDD point to both insulin resistance and insulin deficiency as major contributing factors to this complication, suggesting different mechanisms underlying erectile dysfunction in these subgroups.Graphical abstract

Highlights

Erectile dysfunction, defined as the persistent inability to obtain or maintain a penile erection during sexual intercourse [1], is a disorder affecting mainly men older than 40 years [2] and is associated with poor relationship quality, low life satisfaction and low self-esteem [3]
Several studies demonstrated that distal sensorimotor polyneuropathy (DSPN), cardiac autonomic neuropathy (CAN), CVD, non-alcoholic fatty liver disease (NAFLD), depression and hypogonadotropic hypogonadism increase the risk of erectile dysfunction [9,10,11,12,13]
Our study shows that novel diabetes subgroups have different prevalences of erectile dysfunction

Summary

Introduction

Erectile dysfunction, defined as the persistent inability to obtain or maintain a penile erection during sexual intercourse [1], is a disorder affecting mainly men older than 40 years [2] and is associated with poor relationship quality, low life satisfaction and low self-esteem [3]. Erectile dysfunction is associated with an increased risk of future cardiovascular events, CHD, stroke and all-cause mortality [2, 4, 5]. The higher risk of erectile dysfunction in diabetes is associated with higher age, sedentary lifestyle and the presence of the metabolic syndrome (i.e. hyperglycaemia, hypertension and obesity) [7, 8]. Several studies demonstrated that distal sensorimotor polyneuropathy (DSPN), cardiac autonomic neuropathy (CAN), CVD, non-alcoholic fatty liver disease (NAFLD), depression and hypogonadotropic hypogonadism increase the risk of erectile dysfunction [9,10,11,12,13]. Available epidemiological data report a higher prevalence of erectile dysfunction in men with type 2 diabetes than those with type 1 diabetes. An updated assessment of the prevalence of erectile dysfunction is timely

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