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Erectile Dysfunction in Individuals with Type 1 Diabetes is Associated with Long-term Metabolic Control and Diabetic Complications: A Cross-Sectional Study
Background Erectile dysfunction (ED) affects approximately 38% of individuals with type 1 diabetes (T1DM). Skin autofluorescence (AF) reflects skin advanced glycation end product (AGE) deposits and is a marker of long-term glycemia control.
Objective The study investigates the relationship between ED and diabetes control in patients with T1DM.
Methods Adult patients with T1DM visiting the Diabetology Department were cross-sectionally investigated. Medical history, anthropometric features, and laboratory findings were collected. All individuals filled the International Index of Erectile Function (IIEF-5). IIEF-5 total score < 22 represented the presence of ED. AF was measured on the volar aspect of the forearm using AGE Reader. Insulin resistance (IR) was assessed by the estimated glucose disposal rate. Descriptive statistics and multivariate logistic regression analyses were performed. The adjusted covariates were general risk factors of ED.
Results Of a total of n = 70 patients, n = 30 (42.9%) suffered from ED. The presence of ED was associated with higher glycated hemoglobin level (OR, 95% CI; 1.62, 1.02–2.60; p = 0.043), presence of at least one diabetic complication (3.49, 1.10–11.03; p = 0.03), and skin AF (9.20, 1.60–52.94; p = 0.01), but not with IR (0.78, 0.57–2.60; p = 0.12). Skin AF values ≥ 2.2 indicates presence of ED with a sensitivity of 70.0% and a specificity of 77.5%. Area under the curve was equal to 0.72 (95% CI: 0.60–0.85).
Conclusions The presence of ED in individuals with T1DM is associated with HbA1c, the presence of at least one diabetic complication, and skin AF.
Keywordsskin autofluorescence - insulin resistance - diabetic complications - glycated hemoglobin - advanced glycation end product - C-reactive protein - hypertension
Concept: M.Ka., A.U.; Data collection: M.Ka., M.Ku., P.L., D.K., A.K., M.Ko., D.K., A.U., M.M., D.Z.Z.; Statistical analysis: M.Ka.; Figures and tables preparation: M.Ka.; Original manuscript preparation: M.Ka.; Critical review and final manuscript approval: M.Ka., M.Ku., P.L., D.K., A.K., M.Ko., D.K., A.U., M.M., D.Z.Z.
The study was approved by the Ethical Committee of Poznan University of Medical Sciences (nr of consent 67/19).
Article published online:
13 January 2022
© 2022. International College of Angiology. This article is published by Thieme.
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- 1 Diabetes Poland Collaboration. 2018 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology 2018; 7 (01) 1-90 DOI: 10.5603/DK.2018.0001.
- 2 Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, Siebenhofer A. Cochrane Metabolic and Endocrine Disorders Group. Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database of Systematic Reviews 2014; (02) CD009122
- 3 Pop-Busui R, Hotaling J, Braffett BH. et al; DCCT/EDIC Research Group. Cardiovascular autonomic neuropathy, erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes: findings from the DCCT/EDIC. J Urol 2015; 193 (06) 2045-2051
- 4 Ramírez R, Pedro-Botet J, García M. et al; Xarxa de Unitats de Lípids i Arteriosclerosi (XULA) Investigators Group. Erectile dysfunction and cardiovascular risk factors in a Mediterranean diet cohort. Intern Med J 2016; 46 (01) 52-56
- 5 Skrypnik D, Bogdański P, Musialik K. [Obesity–significant risk factor for erectile dysfunction in men]. Pol Merkuriusz Lek 2014; 36 (212) 137-141
- 6 Andersen ML, Santos-Silva R, Bittencourt LRA, Tufik S. Prevalence of erectile dysfunction complaints associated with sleep disturbances in Sao Paulo, Brazil: a population-based survey. Sleep Med 2010; 11 (10) 1019-1024
- 7 Furukawa S, Sakai T, Niiya T. et al. Self-reported sitting time and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: The Dogo Study. J Diabetes Complications 2017; 31 (01) 53-57
- 8 Kovac JR, Labbate C, Ramasamy R, Tang D, Lipshultz LI. Effects of cigarette smoking on erectile dysfunction. Andrologia 2015; 47 (10) 1087-1092
- 9 Bortolotti A, Fedele D, Chatenoud L. et al. Cigarette smoking: a risk factor for erectile dysfunction in diabetics. Eur Urol 2001; 40 (04) 392-396 , discussion 397
- 10 Wang X-M, Bai Y-J, Yang Y-B, Li J-H, Tang Y, Han P. Alcohol intake and risk of erectile dysfunction: a dose-response meta-analysis of observational studies. Int J Impot Res 2018; 30 (06) 342-351
- 11 Kouidrat Y, Pizzol D, Cosco T. et al. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med 2017; 34 (09) 1185-1192
- 12 Walsh TJ, Hotaling JM, Smith A, Saigal C, Wessells H. Men with diabetes may require more aggressive treatment for erectile dysfunction. Int J Impot Res 2014; 26 (03) 112-115
- 13 Behrend L, Vibe-Petersen J, Perrild H. Sildenafil in the treatment of erectile dysfunction in men with diabetes: demand, efficacy and patient satisfaction. Int J Impot Res 2005; 17 (03) 264-269
- 14 Vistoli G, De Maddis D, Cipak A, Zarkovic N, Carini M, Aldini G. Advanced glycoxidation and lipoxidation end products (AGEs and ALEs): an overview of their mechanisms of formation. Free Radic Res 2013; 47 (01, Suppl 1): 3-27
- 15 Giacco F, Brownlee M. Oxidative stress and diabetic complications. Circ Res 2010; 107 (09) 1058-1070
- 16 Simó-Servat O, Planas A, Ciudin A, Simó R, Hernández C. Assessment of advanced glycation end-products as a biomarker of diabetic outcomes. Endocrinol Diabetes Nutr (Engl Ed) 2018; 65 (09) 540-545
- 17 Kouidrat Y, Zaitouni A, Amad A. et al. Skin autofluorescence (a marker for advanced glycation end products) and erectile dysfunction in diabetes. J Diabetes Complications 2017; 31 (01) 108-113
- 18 Trussell JC, Legro RS. Erectile dysfunction: does insulin resistance play a part?. Fertil Steril 2007; 88 (04) 771-778
- 19 Chen S, Wu R, Huang Y. et al. Insulin resistance is an independent determinate of ED in young adult men. PLoS One 2013; 8 (12) e83951
- 20 Yao F, Liu L, Zhang Y. et al. Erectile dysfunction may be the first clinical sign of insulin resistance and endothelial dysfunction in young men. Clin Res Cardiol 2013; 102 (09) 645-651
- 21 Wu Y-X, Yang C-T, Li N. et al. How does diabetes impair penile tissues during erectile dysfunction?. Endocr Metab Immune Disord Drug Targets 2020; 20 (09) 1535-1542
- 22 Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007; 165 (06) 710-718
- 23 Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11 (06) 319-326
- 24 Drosdzol A, Skrzypulec V. Quality of life and sexual functioning of Polish infertile couples. Eur J Contracept Reprod Health Care 2008; 13 (03) 271-281
- 25 Plinta R, Sobiecka J, Drosdzol-Cop A, Nowak-Brzezińska A, Kobiołka A, Skrzypulec-Plinta V. Sexual health of Polish athletes with disabilities. Int J Environ Res Public Health 2015; 12 (07) 7417-7429
- 26 Wojciechowska-Zdrojowy M, Reid A, Szepietowski JC, Wojciechowski A. Analysis of sexual problems in men with psoriasis. J Sex Marital Ther 2018; 44 (08) 737-745
- 27 Cordova CM, Schneider CR, Juttel ID, Cordova MM. Comparison of LDL-cholesterol direct measurement with the estimate using the Friedewald formula in a sample of 10,664 patients. Arq Bras Cardiol 2004; 83 (06) 482-487 , 476–481
- 28 Williams KV, Erbey JR, Becker D, Arslanian S, Orchard TJ. Can clinical factors estimate insulin resistance in type 1 diabetes?. Diabetes 2000; 49 (04) 626-632
- 29 Meerwaldt R, Graaff R, Oomen PHN. et al. Simple non-invasive assessment of advanced glycation endproduct accumulation. Diabetologia 2004; 47 (07) 1324-1330
- 30 Wei T, Simko V, Levy M, Xie Y, Jin Y, Zemla J. Visualization of a Correlation Matrix. Accessed December 10, 2019 at: https://cran.r-project.org/web/packages/corrplot/corrplot.pdf
- 31 Ahmed Khan R, Brandenburger T. Performance Assessment of Binary Classifier with Visualization. Accessed December 8, 2019 at: https://cran.microsoft.com/web/packages/ROCit/ROCit.pdf
- 32 Bak E, Marcisz C, Krzeminska S, Dobrzyn-Matusiak D, Foltyn A, Drosdzol-Cop A. Does type 1 diabetes modify sexuality and mood of women and men?. Int J Environ Res Public Health 2018; 15 (05) 958
- 33 Maiorino MI, Bellastella G, Della Volpe E. et al. Erectile dysfunction in young men with type 1 diabetes. Int J Impot Res 2017; 29 (01) 17-22
- 34 Klein R, Klein BEK, Moss SE. Ten-year incidence of self-reported erectile dysfunction in people with long-term type 1 diabetes. J Diabetes Complications 2005; 19 (01) 35-41
- 35 Wessells H, Penson DF, Cleary P. et al; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes. J Urol 2011; 185 (05) 1828-1834
- 36 Palmer MR, Holt SK, Sarma AV. et al; Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications Research Group. Longitudinal patterns of occurrence and remission of erectile dysfunction in men with type 1 diabetes. J Sex Med 2017; 14 (10) 1187-1194
- 37 Malavige LS, Levy JC. Erectile dysfunction in diabetes mellitus. J Sex Med 2009; 6 (05) 1232-1247
- 38 Fisher WA, Meryn S, Sand M. et al. Communication about erectile dysfunction among men with ED, partners of men with ED, and physicians: The Strike Up a Conversation Study (Part I). J Mens Health Gend 2005; 2 (01) 64-78
- 39 Levine LA, Kloner RA. Importance of asking questions about erectile dysfunction. Am J Cardiol 2000; 86 (11) 1210-1213 , A5
- 40 Willers C, Iderberg H, Axelsen M. et al. Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study. PLoS One 2018; 13 (06) e0199170
- 41 Weinberg AE, Eisenberg M, Patel CJ, Chertow GM, Leppert JT. Diabetes severity, metabolic syndrome, and the risk of erectile dysfunction. J Sex Med 2013; 10 (12) 3102-3109
- 42 Russo GI, Cimino S, Fragalà E. et al. Insulin resistance is an independent predictor of severe lower urinary tract symptoms and of erectile dysfunction: results from a cross-sectional study. J Sex Med 2014; 11 (08) 2074-2082
- 43 Seftel AD, Vaziri ND, Ni Z. et al. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology 1997; 50 (06) 1016-1026
- 44 Gurbuz N, Sagdic G, Sanli A. et al. Therapeutic effect of combination of alagebrium (ALT-711) and sildenafil on erectile function in diabetic rats. Int J Impot Res 2012; 24 (03) 114-121
- 45 Hatzimouratidis K. Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence. Clin Interv Aging 2006; 1 (04) 403-414
- 46 Lu C-C, Jiann B-P, Sun C-C, Lam H-C, Chu C-H, Lee J-K. Association of glycemic control with risk of erectile dysfunction in men with type 2 diabetes. J Sex Med 2009; 6 (06) 1719-1728
- 47 Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab 2015; 19 (01) 160-164