Erectile Dysfunction as a Manifestation of Newly Diagnosed Diabetes: A Case Report

The prevalence of diabetes mellitus (DM) continues to rise worldwide. One possible complication of this condition is microangiopathy, with erectile dysfunction (ED) being a common example. The impact of DM on ED is significant, as it is estimated that more than half of men with type 2 diabetes (T2D) suffer from this condition. Furthermore, the likelihood of a man with DM developing ED is much higher than that of a non-diabetic man. We present the case of a 39-year-old man who sought medical consultation for ED that had been progressing for two months. His medical history was unremarkable, and he was not taking any regular medication. He is the father of six children. Using the International Index of Erectile Function - 5 (IIEF-5) to assess ED, he was classified as having "severe erectile dysfunction". Physical examination was unremarkable except for being overweight (body mass index: 27.1 kg/m²). Laboratory tests revealed slightly low total and free testosterone levels and a fasting glucose level of 146 mg/dL. Repeat testing confirmed elevated glucose levels, with a hemoglobin A1c of 6.9%. A diagnosis of DM was established, and the patient started metformin, which led to improvement of his initial complaint. This case highlights that when treating a patient with ED, it is essential to perform a thorough differential diagnosis that includes major causes of this condition, particularly DM. The earlier DM treatment is initiated, the sooner complications such as ED can be prevented. Family physicians play a crucial role in identifying and addressing this issue, not only because it is often underreported but also because it may serve as an early marker of cardiovascular risk.