Presentation Authors: Luca Boeri*, Paolo Capogrosso, Eugenio Ventimiglia, Edoardo Pozzi, Nicolò Schifano, Francesco Chierigo, Rani Zuabi, Costantino Abbate, Federico Dehò, Milan, Italy, Vincenzo Mirone, Naples, Italy, Franco Gaboardi, Montanari Emanuele, Francesco Montorsi, Andrea Salonia, Milan, Italy
Introduction: Previous studies have shown that the prevalence of and severity of erectile dysfunction (ED) is higher in men with prediabetes (PreDM) and diabetes mellitus (DM) than among healthy controls. Moreover, it has been reported that glucose disorders are common but unrecognized diseases. We aimed to investigate rate of and clinical characteristics of men with undiagnosed glycemic control impairment seeking medical help for ED as their primary compliant.
Methods: Data from 681 men were analyzed; of them, 92 (13.5%) patients with a previous diagnosis of DM were excluded. The final cohort included 589 (86.5%) men with ED but without a known alteration of glycemic control at presentation. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). Glucose impairment was defined as fasting blood glucose (FBG) >101 mg/dL. Prediabetes was defined according to the criteria of the American Diabetes Association (2015).
Results: Of 589, 171 (29.0%) patients had undiagnosed glucose impairment. Of them, 139 (23.6%) and 32 (5.4%) patients had glucose levels suggestive for either PreDM or DM, respectively (both = Group 1). Patients in Group 1 were older (p < 0.001) and had higher BMI (p=0.002) than controls (Group 2). Groups were comparable in terms of CCI, smoking and alcohol intake. Median (IQR) testosterone levels were lower in Group 1 than Group 2 patients [3.8 (2.4) vs. 4.6 (2.6); p=0.002]. IIEF-EF [11.5 (18) vs. 16 (15); p=0.03] and IIEF-orgasmic function [5 (5) vs. 8 (5); p=0.012] domain scores were lower in Group 1 than Group 2. Severe ED was more frequent in Group 1 than in Group 2 (44.4% vs. 34.0%; p < 0.01). FBG was inversely associated with IIEF-EF (r=-0.1; p=0.04) and IIEF-orgasmic function (r=-0.14; p=0.003) domains.
Conclusions: One in three men seeking first medical help for ED have undiagnosed alteration of glycemic control. Men with impaired FBG showed worse metabolic and hormonal profiles than healthy controls. Hyperglycemia was also associated with higher rate of severe ED and lower orgasmic function scores. These results further stress the importance of a comprehensive metabolic work-up in men presenting for ED.