Erectile Dysfunction in Men
1-Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain penile erection sufficient for satisfactory sexual intercourse.
2-patients with type 2 DM and assessed for the presence and severity of ED by international index of erectile function (IIEF), the prevalence was 90%.
3-Patients with poor glycaemic control were 12.2 times as likely to report ED as those with good glycaemic control.
4-Study showed that HBA1c was an independent predictor of EF score.
5-mean HBA1c level was significantly higher in diabetic patients with ED than those without ED.
6-When multiple logistic regression analysis was used to identify significant independent risk factors for all type of ED, HBA1c showed only a weak independent relationship with the development of diabetic-related ED.
7-Patients with ED had a significantly higher mean HBA1c level than those without ED in younger age group. However there was no significant difference in mean HBA1c level between those with or without ED in the older age group. Also, the mean HBA1c level was significantly higher in those with sever ED than those without sever ED among the younger group, while the mean HBA1c level did not show significant difference between those with sever ED and those without among the older group.
8-Penile erection is defined as the result of smooth muscle relaxation in the cavernous body and associated blood vessels.Nitric oxide (NO) playsa major role in this process as it is one of the most potent endogenous smooth muscle relaxants.
9-Study found that patients reporting ED were generally older, and the prevalence of ED rose significantly with age.
10-multiple logistic regression analysis was used to identified risk factors for all type of ED.
11-When the subjects were stratified according to ED level, there was a significant trends relating the severity of ED to HBA1c.
12-N. H. Cho et al.showed a significant positive association between complete ED with subjects who were on insulin treatment and subjects with either neuropathy or macrovascular disease. However, complete ED was not significantly related to either hypertension or smoking status. On the other hand, Subjects who were on diet therapy alone had rates of complete ED only 0.59 times of those receiving the other treatments.
13-four Studiesshowed that the prevalence of ED was positively associated with subjects age and duration of diabetes.
14-Systematic review of observational studies had concluded that the risk of ED is higher in current and former smokers than never smokers, although smoking cessation may be associated with a lower risk of ED than current smoking.
15-When the subjects were stratified according to ED status (Normal, mild, moderate and complete), there was a significant trend relating the severity of ED to the duration of alcohol consumption (P <0.001), but, in the same study and when multiple logistic regression analysis was used to identify significant independent risk factors for alltype of ED: Alcohol consumption (P <0.05) and Exercise (P <0.01) were independent negative risk factors. Physical activity had a protective effect against ED in additional study F Giugliano et al.An assessment of the association between ED and physical activity was performed in population based studies with meta-analysis, showed lowering the risk of ED with higher physical activity. In the Look AHEAD (action for health in diabetes),among the 373 diabetic men aged 45-75 years, cardiorespiratory fitness was found to be protective of ED. One more study De Berardis et al(4), measured quality of life in diabetic patients with ED, and itdemonstrated that exercise can help prevent ED.
16-A systematic review of the association between ED and cardiovascular disease(37), showed that ED could be an indicator of systematic endothelial dysfunction. SinceED usually precedes CVD onset, it might be considered an early marker of symptomatic CVD.
17-When the subjects were stratified according to ED status (Normal, mild, moderate and complete), there were significant trends relating the severity of ED.
18-Subjects who exercised regularly had rate of complete ED 0.62 times those of alcohol abstainers or sedentary subjects.
19-Subjects who were on insulin treatment 6.1 times more likely to have complete ED than non-insulin users.
20-Subjects who were on diet therapy alone had rates of complete ED only 0.59 times of those receiving the other treatments (95% CI 0.36-0.95, P<0.001)
21-Subjects with either neuropathy or macrovascular disease were, respectively, 1.8 times (95% CI 1.11-2.9, P<0.05) and 3.5 times (95% CI 1.14-10.6, P<0.05) as likely to have complete ED as those subjects without such complications
22-Complete ED was not significantly related to either HTN or smoking status
23-Age and duration were independent POSITIVE risk factors for all types of ED.BUT, Alcohol consumption and Exercise were independent NEGATIVE risk factors. Moreover, HBA1c showed only WEAK independent relationship with the development of diabetic-related ED.
24-Patents with a greater than 10 years history of DM were 3 times as likely to report ED as those with a history of less than 5 years (P = 0.0001).
25-Patients with poorglycaemic control were 12.2 times as likely to report ED as those with good glycaemic control
26-After EF scores were stratified by the level of glycemic control :
27-Mean EF score decreased as HBA1c increased.
28-There was a significant correlation of HBA1c with neuropathy but NOT with participant age, duration of DM or some medication use(data not shown)
29-Multivariate analysis showed that HBA1c was an independent predictor of EF score (P <0.001) even after adjusting for peripheral neuropathy, which was also an independent predictor (P= 0.023)
30-When subject age and DM duration were included in multivariate models, only HBA1c and neuropathy were significant independent predictors of EF score.
31-The mean HBA1c level was significantly higher in diabetic patients with ED than those without ED.
32-The prevalence of ED was POSITIVELY correlated with subjects age and duration of diabetes.
33-Higher HBA1c level was associated with a higher risk of ED with borderline significant.
34-The Odds Ratio of ED for risk factors after adjusted for age and DM duration: ONLY HBA1c level was significantly associated with ED risk.
35-The prevalence of ED was 66.7% in younger group, and 93.1% in the older group.
36-Those with ED had a significantly higher mean HBA1c level than those without ED in younger group.
37-There was no significant difference in mean HBA1c level between those with or without ED in the older group.
38-The mean HBA1c level was significantly higher in those with sever ED than those without sever ED among the younger group.
39-The mean HBA1c level did not show significant difference between those with sever ED and those without among the older group.
