Clinical characteristics of type 2 diabetes mellitus patients with erectile dysfunction

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder and erectile dysfunction (ED) is a common complication among male patients with T2DM. Although T2DM is a well-established independent risk factor for ED the clinical characteristics and associated psychosocial burden of ED in this population remain inadequately characterized. This study aimed to comprehensively assess the prevalence, severity, clinical correlates, and emotional comorbidities of ED in male patients with T2DM.

The incidence and related factors of T2DM patients with ED (T2DMED) were investigated by clinical symptom collection and related scale evaluation. The emotional abnormalities of T2DMED patients and their relationships with clinical features were evaluated by the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD).

A total of 208 male patients with T2DM who presented to the Department of Endocrinology in Jiangsu Provincial People's Hospital from July 2020 to March 2021 were selected. The demographic information and T2DM related clinical data were collected. The scales of HAMA, HAMD, and sexual function questionnaires including International Erectile Function Index (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT) and Arizona Sexual Experience Scale (ASEX) were evaluated. Statistical analysis was conducted based on the patient's demographic information, clinical indicators, and scale data.

The prevalence of ED in male patients with T2DM was 67.8%. The prevalences of mild, moderate and severe ED were 57.2%, 5.3%, 5.3%, respectively. Compared with the group of T2DM, higher age, lower IIEF score, higher PEDT score, higher ASEX score, increased left and right pulse wave velocity (PWV) were detected in the T2DMED group. In addition, age and fasting insulin had positive impacts on the development of ED in T2DM patients. HbA1C, age and educational level had impacts on the severity of ED. The severity of ED was positively correlated with low-density lipoprotein (LDL) level, age, left ankle brachial index (ABI), left and right PWV. There were negative correlations between IIEF-5 scores and HAMA, HAMD scores in T2DM patients. PEDT scores were positively correlated with HAMA and HAMD scores while ASEX scores were positively correlated with HAMA scores. The HAMA scores were positively correlated with the duration of T2DM and HAMA scores had negative effects on IIEF scores.

Mild ED is more common in T2DM patients with more serious sexual dysfunction and higher risk of diabetic vasculopathy. Higher age and fasting insulin level are associated with the development of T2DMED while HbA1C, age and education level affect the severity of ED, with higher levels of low-density lipoprotein (LDL) and age, high risk of diabetic vasculopathy indicating more severe ED. The sexual dysfunction was positively associated with both anxiety and depression, especially in patients with higher age.