|Year : 2016 | Volume
| Issue : 1 | Page : 1-2
Erectile dysfunction and diabetes mellitus
Rajendra B Nerli1, Neeraj S Dixit1, Shridhar C Ghagane2
1 Department of Urology, KLE Kidney Foundation, KLE'S Dr. Prabhakar Kore Hospital and MRC, KLE University, Belgaum, India
2 Department of Studies in Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India
|Date of Web Publication||2-Feb-2016|
Rajendra B Nerli
Department of Urology, KLE Kidney Foundation, KLE'S Dr. Prabhakar Kore Hospital and MRC, KLE University, Belgaum
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nerli RB, Dixit NS, Ghagane SC. Erectile dysfunction and diabetes mellitus. J Sci Soc 2016;43:1-2
Erectile dysfunction (ED) is described as a persistent inability (more than 6 months) to attain and maintain an erection sufficient to have a satisfactory sexual performance.  Male sexual dysfunction, which includes disorders of libido, ejaculatory problems, and ED, is a common but underappreciated complication of diabetes [diabetes mellitus (DM)]. ED is associated with a reduced quality of life (QoL), and unfortunately occurs at an earlier age in diabetic patients compared with the general population. ED may occur early in diabetes, and occasionally may present as the chief/primary complaint of a diabetic patient. Total cost for the treatment of patients suffering from ED in the United States is estimated to be US$400 million, and approximately one-fourth of them are paid for diabetes-related ED. 
The prevalence of ED among diabetic men ranges between 35% and 90%.  Our own unreported series has shown an incidence >50% ED in diabetic males aged 21-60 years. A longer duration of DM and poorer glycemic control in diabetic men have been reported by some studies previously as the predictors of ED in DM. , The link between ED and impaired QoL justifies the treatment of ED in diabetic men as an important public health issue. Most men with ED benefit from treatment. Treatment options include psychosexual counseling, pharmacological treatment, and mechanical or surgical intervention. Among the pharmacological options, oral treatment with on-demand phosphodiesterase type 5 inhibitors (PDE-5 inhibitors) is now considered a first-line therapy because it is convenient, effective, and generally well-tolerated. PDE-5 inhibitors block the action of PDE-5 causing cyclic guanosine monophosphate (cGMP) to accumulate. This amplifies the neural NO/cGMP pathway that is essential for the relaxation of smooth muscle and subsequent penile tumescence. As such, these drugs restore a satisfactory erectile response to sexual stimulation.  Sildenafil was the first PDE-5 inhibitor to be introduced into clinical practice. Two further PDE-5 inhibitors, tadalafil and vardenafil have shown improved potency and selectivity for PDE-5 inhibition in experimental as well as clinical studies.
All three PDE-5 inhibitors were significantly superior to the placebo in improving erectile response to sexual stimulation in diabetic patients. Measurements of effect on the index of erectile function (IIEF) erectile function (EF) domain score demonstrate this. In the vardenafil trial (our department was part of the trial), baseline EF domain scores for patients subsequently receiving placebo, 10 mg, and 20 mg of vardenafil were 11.2, 11.0, and 12.4, respectively. After 12 weeks of treatment, the EF domain score in placebo-treated patients had increased minimally to 12.6 but the final scores for 10 mg vardenafil were significantly higher at 17.1 (P < 0.0001 versus placebo) and 19.0 for 20 mg vardenafil (P < 0.0001 versus placebo). , When counseling diabetic men who are considering a PDE-5 inhibitor for ED, it is important to set realistic expectations and explain that studies document that all three agents are less effective in diabetic patients than in the general population of men with ED.
There are very few reports specifically relating to the effectiveness of vacuum erection devices (VEDs) in diabetic men with ED. A recent review of the use of VEDs in the general treatment of ED notes that the satisfaction rates with this therapy are much lower, varying between 20% and 50%.  In diabetic patients who fail medical management of ED, penile implantation surgery remains a viable therapeutic option.
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