Risk factors for erectile dysfunction in patients with newly diagnosed diabetes mellitus.

Abstract

To evaluate risk factors of erective dysfunction (ED) and find out incidence in patients with newly diagnosed diabetes mellitus.
All patients from Centre for Diabetes with newly diagnosed diabetes mellitus type 2 are involved in study. We have done interview using questionnaire-International Index of Erectile Function (IIEF)-5. Result of IIEF-5 less than 21 was used as bottom line for identification of patients with ED.
Newly diagnosed diabetes mellitus type 2 was a case in 243 patients from which 37% of them had ED. Comparing potent man with those with ED there are statistically significant difference according to smoking, duration of smoking, hypertension, body mass index and serum level of glycozated hemoglobin HbA1c. Using multivariate logistic regression model, age was identified as the most significant risk factor.
Patients with newly diagnosed diabetes mellitus have high prevalence of ED which can be related with other risk factors such as age of diabetes onset, hypertension, smoking and body mass index.

Full text

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MED ARH 2010; 64(6) • ORIGINAL PAPER
Risk Factors for Erectile Dysfunction in Patients with Newly Diagnosed Diabetes Mellitus
original paper
Risk Factors for Erectile Dysfunction in Patients with Newly
Diagnosed Diabetes Mellitus
Dzelaludin Junuzovic1, Munira Hasanbegovic1, Izet Masic2
Urology Clinic, Clinical Center of University of Sarajevo, B&H1, Academy of Medical Sciences of B&H, Sarajevo, Bosnia and Herzegovina2
g
newly diagnosed diabetes mellitus type 2 are involved in study. We have
done interview using questionnaire–International Index of Erectile Function
(IIEF)-5. Result of IIEF-5 less than 21 was used as bottom line for identifica-
tion of patients with ED. Results: newly diagnosed diabetes mellitus type
2 was a case in 243 patients from which 37% of them had ED. Comparing
potent man with those with ED there are statistically significant difference
according to smoking, duration of smoking, hypertension, body mass index
and serum level of glycozated hemoglobin HbA1c. Using multivariate logis-
tic regression model, age was identified as the most significant risk factor.
Conclusion: Patients with newly diagnosed diabetes mellitus have high
prevalence of ED which can be related with other risk factors such as age of
diabetes onset, hypertension, smoking and body mass index. Key words:
erectile dysfunction, risk factors, diabetes mellitus
oal: To evaluate risk factors of erective dysfunction (ED) and find
out incidence in patients with newly diagnosed diabetes mellitus.
Material and methods: All patients from Centre for Diabetes with
Corresponding author: prof Dzelaludin Junuzovic, MD, phD. Urology clinic, CCU, 71000 sarajevo, Bolnicka 25.
1. INTRODUCTION
Type 2 diabetes mellitus (DM) is a
common, serious disease that leads to
the risk of cardiovascular mortality,
which is 2 to 4 times more common in
this group than in patients without DM.
This increased risk is already present
in newly diagnosed patients, and this
is one of the reasons why screening for
type 2 DM is recommended. The risk
is higher because patients with type 2
diabetes have asymptomatic phase be-
tween the beginning of diabetic hyper-
glycemia and clinical diagnosis made
at the end. This stage lasts at least 4-7
years (1,2,3).
This untreated hyperglycemia may
explain the relatively high prevalence
of microvascular complications (up
to 48%) and macrovascular complica-
tions (40%) in patients with newly di-
agnosed DM (1).
One of the most common complica-
tions of diabetes mellitus type 2 is the
erectile dysfunction (ED). Under these
conditions, ED is associated with re-
duced quality of life and occurs at an
earlier age than in the general popula-
tion. It appears frequently in terms of
clinical disease and represents a prob-
lem.
Several studies have researched the
prevalence and predictors of ED in pa-
tients with type 2 DM but no studies
in newly diagnosed cases of DM. Early
diagnosis and treatment of ED in these
men can prevent or delay progression,
and can improve quality of life of these
people. The aim of this study was to
determine the prevalence and assess
the risk factors for ED in patients with
newly diagnosed type 2 DM (2,3).
2. MATERIAL AND METHODS
During the period from January
2007 until June 2010 conducted is an
open prospective study that included
patients with newly diagnosed DM from
the time of conducting interviews. In
this way, 243 patients with type 2 DM,
aged 24-65 years, were included in the
study. In accordance with WHO recom-
mendations, type 2 DM was diagnosed
when the following conditions are met:
the patient who have symptoms of hy-
perglycemia, measured fasting capillary
blood glucose >6.1 mmol/L or fasting
plasma glucose level >=7.0 mmol/L on
two occasions, for patients with symp-
toms of hyperglycemia, a blood glu-
cose measured in full capillary blood
>=6.1 mmol/L or plasma glucose >=7.0
mmol/L.
All patients were examined by an
experienced diabetologist with an in-
terview about their sexual life. During
the interview, the doctor explained the
meaning of the ED before asking ques-
tions about the occurrence of ED dur-
ing last 12 months. An abbreviated ver-
sion of the International Index of Erec-
tile Function (IIEF) -5 was applied in all
patients. Patients with score 5-25 were
considered to have ED. Risk factors such
as age, education, smoking, was tested
by direct questions. Body mass index

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MED ARH 2010; 64(6) • ORIGINAL PAPER
Risk Factors for Erectile Dysfunction in Patients with Newly Diagnosed Diabetes Mellitus
(BMI) is based on the weight during
three months from setting diagnosis.
Blood pressure was calculated as the
mean of two measurements in the sit-
ting position after 5 min of rest.
The patient was considered to be
hypertensive if diastolic pressure was
>=90mmHg, systolic blood pressure
>=140mmHg, and/or taking antihyper-
tensive drugs.
Hypercholesterolemia was defined
as serum cholesterol >= 6.2 mmol/L,
while the marginal hypercholesterol-
emia defined as a level between 5.2-6.2
mmol/L. Statistical analysis starts with
descriptive methods and continues to
test links between ED and potential risk
factors. Multivariate logistic regression
allows the identification of independent
predictors that were significantly asso-
ciated with ED, where p<0.05 consid-
ered to indicate a significant statistical
significance.
3. RESULTS
Table 1 shows the clinical charac-
teristics of patients with newly diag-
nosed diabetes mellitus type 2, which
included 243 patients with newly di-
agnosed DM, with the average age of
42.9±1.7 years. In the sample there was
15.5% smokers and 8.8% had hyperten-
sion. The prevalence of ED in patients
with newly diagnosed type 2 diabetes
mellitus is 37%. Comparing with po-
tent patients, patients with ED have
significant differences in serum levels
of HbA1c, smoking habits, duration of
smoking, BMI and hypertension. When
multivariate logistic models are used to
identify independent predictors of ED,
the four main risk factors were signif-
icantly and independently associated
with ED, most notably the age.
Comparison with patients <40
years, patients aged 40-50 years have al-
most five times greater risk of ED, while
patients >50 are at nine times greater
risk. Smoking, hypertension and BMI
were independently associated with
ED. Smokers have almost three times
greater chance of ED than nonsmokers.
And people with hypertension had dou-
ble the risk of ED. Weight and obesity
produce higher risk for ED, five times
and twice, approximately, than in peo-
ple with normal BMI.
4. DISCUSSION
In this study the prevalence of ED
was 37% and increases with age. The
main determinants of risk were age,
hypertension, smoking and BMI. Many
studies have shown that the prevalence
of ED in diabetic patients is 20-75%.
These studies were conducted during
different periods, in different conditions
and in different age groups and are not
comparable with this study. Many of
these studies showed significant posi-
tive correlation with duration of diabe-
tes prevalence. It is not surprising that
the prevalence of ED in men with dia-
betes is larger than in newly diagnosed
cases (4,5,6,7).
Influence of age on the ED preva-
lence is well established in healthy and
in people with known DM. Older age
was significantly associated with higher
prevalence of ED, as evidenced by Table
1. By comparing similar age groups the
prevalence in this study, as expected, is
lower. As DM lasts longer, the chance
for ED increases, supporting the etio-
logic significance of DM in the devel-
opment of ED (3,8).
The link between smoking and ED
may be due to the association of smok-
ing with atherosclerosis, which itself
can be the cause of ED in diabetic pa-
tients. In this study, there is a greater
risk of ED among smokers, among those
who smoke, and the index of smoking
was significantly higher in patients with
ED (Table 1).
According to age, hypertension and
BMI, smokers have three times larger
risk of ED (9-12). It has been shown that
smoking increases the risk for ED even
in nondiabetics. Medical conditions
such as hypertension, depression, heart
disease, pelvic trauma and surgery may
be associated with increased risk for ED.
In connection with hypertension ED is
complex and may involve direct effect of
high blood pressure and effects of anti-
  Total number of diabetic patients (n = 243)
With ED
No. (%)
89 (37)
48.8±1.8
Without ED
No. (%)
154(63)
37±1.6Age
Age groups
<40
40-50
>50
Tobacco smoking
Non smoker
Ex-smoker
Smoker
Smoking index
<100
100-200
>200
Obesity
BMI < 30
BMI > 30
Dyslipidemia
Without dyslipidemia
Dyslipidemia
Triglycerides
Cholesterol
LDL
HDL
HbA1c, Mean value
38(16)
112(46)
93(38)
 
117(48)
12(5)
28(11.5)
 
12(5)
9 (3.7)
3(1.2)
142(58.6)
68(28.0)
33(13.4)
 
70(29)
6(2.5)
10(4)
 
6(2.4)
5(2)
3(1.2)
 
58(23.8)
5(2)
 
78(32)
6(2.5)
4(1.6)
6(2.4)
4(1.6)
3(1.2)
6.44
45(18.5)
10(4)
 
22(9)
12(5)
6(2.4)
6(2.4)
7(2.8)
9(3.7)
6.93
Hypertension
Without hypertension
Hypertension
Coronary disease
Without coronary disease
Chronic coronary disease
Table 1. Clinical features of patients with newly diagnosed diabetes mellitus type 2
  
58(23.8)
12(5)
40(16.4)
8(3.3)
59(24.2)
5(2)
49(20.1)
4(1.6)

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MED ARH 2010; 64(6) • ORIGINAL PAPER
Risk Factors for Erectile Dysfunction in Patients with Newly Diagnosed Diabetes Mellitus
hypertensive drugs on microcirculation
(13-16). In this study, according to age,
BMI and smoking, people with hyper-
tension hade two times more often ED
than those who had normal blood pres-
sure. Elevated HbA1c decreased activity
of nitrous oxide and reduced endothe-
lium dependent relaxation factor asso-
ciated with increased risk for ED (9,17).
Several authors have examined the
positive correlation of poor glycemic
control and the 5 year incidence of ED
in diabetic patients. This finding sup-
ports the present results where, com-
paring with patients with HbA1c levels
<8%, patients with HbA1 level >8.1%,
which almost three times more often
have ED. This study shows significant
associations between ED and BMI. De-
spite adjustments to other significant
factors, which suggesting that BMI is an
independent factor associated with ED.
Also, there is a significant linear trend
that allows the statement that the pro-
portion of patients with ED increases
with BMI (10,13,15).
5. CONCLUSION
Patients with newly diagnosed type
2 diabetes mellitus have a high preva-
lence of ED occurrence with the other
risk factors, including age, hyperten-
sion, smoking and BMI.
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