Diabetic men with erectile dysfunction (ED) may need more intense therapies than men without diabetes, according to a recent study in the International Journal of Impotence Research.
Diabetes is known to be associated with ED. However, scientists were not sure whether men with diabetes needed more intense treatment.
For this study, the researchers aimed to determine whether diabetes was associated with more severe ED and whether diabetic men had less success with first-line therapies, thus needing second- and third-line therapies.
In the researchers’ view, oral medication was considered the first line therapy. Second-line therapies included penile suppositories and injections. Penile prostheses were deemed third-line therapies. (Vacuum erection devices were not considered, as their use was not identifiable in the study data.)
The Inovus 13 database, a component of the Urologic Diseases of America project, provided claims-based data used to identify 136,306 men who were diagnosed with ED between January 2002 and December 2006.
Fourteen percent of the men (19,236) had preexisting diabetes. (Men who were diagnosed with erectile dysfunction before being diagnosed with diabetes were excluded.) Claims were followed for 48 months.
The researchers found that the ED rate increased as men got older. The rate was highest among men aged 60 to 64 years and among nonwhites.
Among men with diabetes, 2.8% were treated with second-line therapies – penile suppositories and injections. For non-diabetic men, this rate was 1.8%. Men with diabetes were 60% more likely to start second-line therapies within five years of their ED diagnosis.
For third-line therapies (penile prostheses), the rates were 0.8% for diabetic men and 0.4% for men without diabetes. Therefore, men with diabetes were at least twice as likely to have penile prostheses than men without diabetes.
Rates for combined second- and third-line therapies were 0.13% for diabetic men and 0.06% for non-diabetic men.
The men with diabetes tended to progress toward second- and third-line therapies more quickly than men without diabetes.
“These data suggest that [diabetes]-associated ED may be less responsive to first-line pharmacologic treatment, worsen more rapidly, or both,” the authors wrote.
They acknowledged that their research had some limitations. For example, they were unable to identify men who had ED but had not discussed it with a physician or sought treatment. Also, some men who tried second- and third-line therapies might have tried oral medication without success before the study began.
However, the researchers noted that men with diabetes might benefit from earlier and “possibly more aggressive” ED treatment. When men are diagnosed with diabetes, for example, healthcare providers might discuss the potential for ED later on. This discussion could inspire men to keep their diabetes under control.
“Aggressive erectile dysfunction therapy more likely in men with diabetes”
(February 6, 2014)
International Journal of Impotence Research
Walsh, T. J., et al.
“Men with diabetes may require more aggressive treatment for erectile dysfunction”
(Full-text. December 19, 2013)