Optimizing Treatment for Diabetes Mellitus Induced Erectile Dysfunction

Abstract

Diabetes mellitus affects more than 6.2% of the population in the United States. Therefore, more than 8 million American men have the potential of being affected by diabetes mellitus induced erectile dysfunction (DMED).1 An association between diabetes mellitus and the development of erectile dysfunction has been documented in the literature since 1798.2 In fact, DMED represents one of the largest groups of erectile dysfunction. Between 25% and 75% of men with type 2 diabetes will complain of erectile dysfunction.3 In numerous epidemiological studies the odds ratio of having erectile dysfunction if a man is diabetic is 1.9 to 4 times greater than a population without diabetes, making diabetes one of the greatest risk factors for erectile dysfunction.4, 5 The incidence of DMED has been shown to be age associated. By the age of 30 years approximately 15% of diabetic men have erectile dysfunction, whereas by the age of 60 years 55% will have it. 6–8 Not only does erectile dysfunction occur at a higher frequency in younger patients with diabetes, but also DMED occurs at a greater frequency across all age groups. As the treatment of diabetes improves and patient life spans increase, the importance of quality of life issues in the treatment of diabetes becomes more prominent. Diabetic patients with erectile dysfunction have a significantly poorer quality of life demonstrated by self-reported quality of life indexes. The focus of diabetic therapy in the year 2002 is now directed toward decreasing the sequela of diabetes mellitus, including erectile dysfunction. A review of the mechanisms responsible for causing DMED and a focus on the clinical manifestations of diabetic erectile dysfunction will lead us to improved prevention and treatment of DMED. The purpose of this article is to review research, and preclinical and clinical information related to DMED, and discuss possible treatment, prevention strategies and future goals needed to improve our understanding of the unique pathophysiological attributes of diabetes and erectile dysfunction. MECHANISM OF DMED