Diabesity = Diabetes + Obesity

Type 2 diabetes is reaching pandemic levels and young-onset type 2 diabetes is becoming increasingly common. Erectile dysfunction (ED) is a common and distressing complication of diabetes. The pathophysiology and management of diabetic ED is significantly different to nondiabetic ED.

Aim

To provide an update on the epidemiology, risk factors, pathophysiology, and management of diabetic ED.

Method

Literature for this review was obtained from Medline and Embase searches and from relevant text books.

Main Outcome Measures

A comprehensive review on epidemiology, risk factors, pathophysiology, and management of diabetic Erectile Dysfunction.

Results

Large differences in the reported prevalence of ED from 35% to 90% among diabetic men could be due to differences in methodology and population characteristics. Advancing age, duration of diabetes, poor glycaemic control, hypertension, hyperlipidemia, sedentary lifestyle, smoking, and presence of other diabetic complications have been shown to be associated with diabetic ED in cross-sectional studies. Diabetic ED is multi-factorial in aetiology and is more severe and more resistant to treatment compared with nondiabetic ED. Optimized glycaemic control, management of associated comorbidities and lifestyle modifications are essential in all patients. Psychosexual and relationship counseling would be beneficial for men with such coexisting problems. Hypogonadism, commonly found in diabetes, may need identification and treatment. Maximal doses of phosphodiesterase type 5 (PDE5) inhibitors are often needed. Transurethral prostaglandins, intracavernosal injections, vacuum devices, and penile implants are the available therapeutic options for nonresponders to PDE5 inhibitors and for whom PDE5 inhibitors are contraindicated. Premature ejaculation and reduced libido are conditions commonly associated with diabetic ED and should be identified and treated.

Conclusions

Aetiology of diabetic ED is multi-factorial although the relative significance of these factors are not clear. A holistic approach is needed in the management of diabetic ED.

Psychosexual counseling in diabetic patient

In order to avoid the problems inherent in the assessment of any organic component of impotence, a consecutive series of 20 diabetics were treated with psychotherapy after a detailed assessment of the psychological components of their disability, 13 patients improved in the long term and responders could not be identified from pretreatment characteristics. However, most of the patients had been impotent for several years and their successful adaptation may have limited the success of psychotherapy. There is a need to identify the impotent patient at an early stage in order to offer more effective treatment. This might also avoid the problems of adaptation and the need for detailed investigations of pelvic nervous and vascular function. The management of ED in the diabetic patient may often involve a multidisciplinary approach where psychosexual counseling and specialist sexologist advice is required in addition to the skills of the diabetologist. Finally, the introduction of the new oral agents have completely revolutionized the management of ED and allowed more individuals to come forward for treatment.

Dr. Sharmila Majumdar