Erectile and endothelial dysfunction in Type II diabetes: a possible link

Abstract

Erectile dysfunction (ED) is a common complication and an important cause of decreased quality of life in men with diabetes. These patients present a risk of ED three-fold higher than the general population; the prevalence of ED increases with age, but in diabetic men it can occur 10 to 15 years earlier regardless of their insulin dependency status [1].The causes of ED in diabetic patients can be multifactorial, involving mainly vascular, neurological and Diabetologia (2001) AbstractAims/hypothesis. The aim of this study was to evaluate the relation between erectile dysfunction and endothelial functions, coagulation activation, peripheral and autonomic neuropathy in men with Type II (non-insulin-dependent) diabetes mellitus. Methods. We studied 30 Type II diabetic patients with symptomatic erectile dysfunction and 30 potent diabetic patients matched for age and disease. Endothelial functions were assessed with the l-arginine test, plasma thrombomodulin and cell adhesion molecules circulating concentrations. Haemostasis was evaluated with markers of thrombin activation and fibrinolysis. Quantitative sensory testing (vibratory, warming, and heat-pain thresholds), cardiovascular reflex tests and 24-h blood pressure monitoring were used to assess peripheral or autonomic neuropathy. Results. Mean erectile score and HbA 1 c were 10.5 5.8 and 8.3 1.6 % in patients with erectile dysfunction, and 24.0 0.7 and 6.8 1.4 % in those without erectile dysfunction, respectively (p < 0.001); there was a significant relation between HbA 1 c and erectile function score in patients with erectile dysfunction (r = ±0.45, p = 0.02). The decrease in blood pressure and platelet aggregation in response to l-arginine was lower (p < 0.05±0.02) in patients with erectile dysfunction, whereas soluble thrombomodulin, P-selectin and intercellular cell ahhesion molecule-1 concentrations were higher (p < 0.05±0.02). Indices of coagulation activation (F1 + 2 and d-dimers) and reduced fibrinolysis (PAI-1) were also found to be higher in erectile dysfunction patients. Heat-pain and warm perception thresholds, as well as cardiovascular reflex tests, were most commonly abnormal in patients with erectile dysfunction (p < 0.05). In multivariate analysis, HbA 1 c , MBP response to l-arginine, P-selectin, indices of coagulation, and quantitative sensory testing were independent predictors of erectile function score. Conclusion/interpretation. Erectile dysfunction in diabetic men correlates with endothelial dysfunction. A reduced nitric oxide activity might provide a unifying explanation. [Diabetologia (2001

Endothelial microparticles correlate with erectile dysfunction in diabetic men

“…[1][2][3] Furthermore, individuals with diabetes may have other co-morbid conditions that are associated with ED without diabetes, such as renal failure, hypertension and chronic liver disease, making the precise association of diabetes with ED circumstantial under these conditions. On the other hand, our findings that EMP remain the sole predictor of ED in our diabetic subjects with ED, and the evidence that common risk factors, such as hyperlipidemia and hypertension, do not interfere with the association between EMP and ED suggest that EMP may be one important link between endothelial dysfunction and ED.…”

“…1,2 The relative risk of ED increases with diabetes duration, poor glycemic control and the number of other complications present, including microvascular complications such as nephropathy, neuropathy and retinopathy, and macrovascular atherosclerosis. [1][2][3] One common denominator for these diseases is vascular endothelial dysfunction, and ED may be a marker for the potential development of vascular disease including myocardial infarction. [4][5][6] Vascular endothelium plays a pivotal role in pathogenesis of numerous thrombotic and inflammatory disorders.…”

Prevalence of erectile dysfunction among Chinese men with type 2 diabetes mellitus

“…35,36 Elevated homocysteine concentrations, which directly influence NO levels, have been reported in patients with DM and represent an independent risk factor for ED. 37 Conversely, improvements in endothelial function 38 and ED 39 have been reported after weight loss in obese men with metabolic syndrome.…”

Obesity, the metabolic syndrome, and sexual dysfunction

“…55 Moreover, ED in diabetic men correlates with endothelial dysfunction and endothelial activation, including circulating concentrations of P-selectin and cellular adhesion molecules. 56 In both men and women with the metabolic syndrome, 28,36 the prevalence of sexual dysfunction is significantly higher than age-and weight-matched subjects without the metabolic syndrome, and associated with higher circulating concentrations of CRP. In particular, IIEF score in men is positively associated with endothelial function score and negatively with CRP, while FSFI score in women was negatively associated with CRP levels.…”