Erectile dysfunction, microangiopathy and UKPDS risk in type 2 diabetes

Erectile dysfunction (ED) is a frequent comorbidity in patients with type 2 diabetes mellitus (T2DM), and is now increasingly considered a surrogate marker of endothelial dysfunction as well as a sentinel predictor of new-onset macroangiopathic events. Less attention, however, has been directed at the potential association of ED and microangiopathy in hyperglycaemic states.

We analyzed 221 consecutive male T2DM outpatients in whom ED was assessed by the International Index of Erectile Function (IIEF-5) questionnaire. ED(+) patients (IIEF-5 1-20; n=83) were compared with an age-matched ED(-) cohort (IIEF-5 21-25; n=51), with similar diabetes duration, in terms of cardiovascular (CV) risk factors, micro-/macroangiopathy and the United Kingdom Prospective Diabetes Study (UKPDS) risk score.

Mean age and diabetes duration were 58 and 10 years, respectively. IIEF-5 score (1 S.D) was 23 (1) in ED(-) vs 11 (6) in ED(+). Anamnestic impotence and erectogenic drug use were reported by 52% and 36%, respectively, of ED(+) vs 12% and 8%, respectively, of ED(-) (P<0.0002 and P<0.0001, respectively). The metabolic syndrome prevalence (88% vs 64%; P=0.002) and central adiposity markers (waist, waist/height and visceral fat) were all significantly higher in ED(+). HbA(1c) was similar in both groups: 7.5% (1.3%), and there were also no significant differences in smoking, blood pressure, HOMA insulin sensitivity, cholesterol and glomerular filtration rate. However, prevalences of retinopathy, polyneuropathy and elevated albuminuria, and the composite endpoint of peripheral artery disease, transient ischaemic attacks and/or stroke, were markedly increased in ED(+) (all P<0.05). No differences were observed in coronary artery disease prevalence or in the UKPDS 10-year CV risk between the two ED groups.

IIEF-5-defined ED in men with T2DM is associated with a marked increase in the metabolic syndrome, central adiposity and microangiopathy. These data suggest that diagnosing ED in T2DM warrants detailed screening and monitoring for microangiopathy in target organs.