Background
Men with diabetes develop erectile dysfunction (ED) 10 to 15 years earlier than men in the general population. Other studies have demonstrated associations between glycemic control and ED in men with diabetes.
This study could take this finding further by seeing if a reduction in glycemia can reduce the risk of ED.
Aim
To determine whether intensive glycemic therapy reduces the risk of erectile dysfunction in men with type 1 diabetes enrolled in the Diabetes Control and Complications Trial.
Methods
The Diabetes Control and Complications Trial (DCCT) randomised 761 men with type 1 diabetes to intensive or conventional glycemic therapy at 28 sites between 1983 and 1989, of whom 366 had diabetes for 1 to 5 years and no microvascular complications (primary prevention cohort), and 395 had diabetes for 1 to 15 years with non-proliferative retinopathy or microalbuminuria (secondary intervention cohort).
Subjects were treated until 1993, and subsequently followed in the Epidemiology of Diabetes Interventions and Complications (EDIC) study.
In 2003 the authors conducted an ancillary study using a validated assessment of erectile dysfunction (the IIEF) in 571 men (80% of the EDIC cohort): 291 from the primary prevention cohort and 280 from the secondary prevention cohort of the DCCT.
ED was defined using a single question from the IIEF to encompass both sexually active and sexually inactive men.
Results
Of the participants in the ED study, 23% reported erectile dysfunction.
The prevalence was significantly lower in the intensive therapy vs conventional treatment group (from DCCT) in the secondary intervention cohort (12.8% vs 30.8%, p = 0.001) but not in the primary prevention cohort (17% vs 20.3%, p = 0.49).
The risk of erectile dysfunction in both primary prevention and secondary intervention cohorts was directly associated with mean HbA1c measured during the DCCT, and during the combined period of the DCCT and EDIC.
Age, peripheral neuropathy and lower urinary tract symptoms were other risk factors for ED from multivariable analyses.
Conclusion
A period of intensive therapy significantly reduced the prevalence of erectile dysfunction measured 10 years later among those men in the secondary intervention cohort but not in the primary prevention cohort.
Higher HbA1c was significantly associated with risk of ED in both cohorts. These findings provide further support for early implementation of intensive insulin therapy in young men with type 1 diabetes.
