Erectile dysfunction is an important cause of decreased quality of life in men (1,2). Strong epidemiological evidence links the subsequent risk of erectile dysfunction to the presence of well-recognized risk factors for coronary heart disease, such as increased body weight, hypertension, and dyslipidemia (3,4). Some have suggested that a diagnosis of erectile dysfunction is a sentinel event that should prompt investigation for coronary heart disease in asymptomatic men (5). We postulated an association between erectile dysfunction and the metabolic syndrome because four of the five components of the metabolic syndrome are risk factors for erectile dysfunction and are also characterized by abnormal endothelial function (6). RESEARCH DESIGN ANDMETHODS -Men were recruited among those attending the outpatient department for metabolic diseases of the teaching hospital at the second University of Naples, Naples, Italy. To be enrolled in the study, subjects had to have three or more of the criteria to meet the diagnosis of the metabolic syndrome, as recommended by the Adult Treatment Panel (7). Exclusion criteria were diabetes or impaired glucose tolerance, impaired renal function, pelvic trauma, prostatic disease, peripheral or autonomic neuropathy, hypertension (blood pressure Ͼ140/90 mmHg), cardiovascular disease, psychiatric problems, use of drugs or alcohol abuse, and smoking (both present and past smoking). Endocrine causes of erectile dysfunction were also excluded. A total of 50 men, matched for age and body weight, served as the control group. The study was approved by the institutional committee of ethical practice of our institution, and all of the study subjects gave written informed consent.Erectile function was assessed by completing questions one through five of the International Index of Erectile Function (IIEF), which is a multidimensional questionnaire for assessing erectile dysfunction (8). The erectile function score represents the sum of questions one through five of the IIEF questionnaire, with a maximum score of 25; a score Յ21 indicates erectile dysfunction.Endothelial function was assessed with the L-arginine test, as previously described (9). We developed a score in which the blood pressure and platelet aggregation responses to L-Arginine (3 g i.v.) were summed. This gives a score ranging from 0 points, indicating maximal impairment of endothelial function, to 10 points, indicating normal function of the endothelium (10).Assays for serum total and HDL cholesterol, triglyceride, and glucose levels were performed in the hospital's chemistry laboratory. High-sensitivity C-reactive protein (CRP) was assayed by immunonephelometry on a Behring Nephelometer 2 (Dade Behring, Marburg, Germany).Data are presented as the mean Ϯ SD unless otherwise indicated. We compared baseline data using a t test for continuous variables and Wilcoxon's test for CRP. We classified all study patients as having three, four, or five components of the metabolic syndrome and assessed for evidence of a relationship among erec...

Similar glycemic control occurred with the addition of NPL or glargine insulin to oral regimens in patients with poorly controlled type 2 diabetes. Hypoglycemia was similar in the 2 groups, but sample size limited the ability to make a definite safety assessment.

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