Sexual dysfunction in men with pre-diabetes – results from a cross-sectional study
Boeri, L1; Capogrosso, P1; Pederzoli, F1; Ventimiglia, E1; Cazzaniga, W1; Chierigo, F1; Frego, N1; Pozzi, E1; Dehò, F1; Montanari, E2; Mirone, V3; Gaboardi, F1; Montorsi, F1; Salonia, A1
1: Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; 2: IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Dep. pf Urology; Milan; Italy; 3: Department of Urology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Objectives: Erectile dysfunction (ED) is causally related to diabetes mellitus (DM) and can also be considered as a useful marker for many forthcoming cardiovascular diseases (CVDs). Prediabetes (pDM) is considered a risk factor for the further development of both DM and CVDs. The association between pDM and ED has been scantly analysed. We aimed to assess the association between pDM and sexual health in a cohort of men seeking medical help for ED as their primary compliant.
Materials and Methods: Data from 372 men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the IIEF-EF domain (categorized according to Cappelleri’s criteria). Men were defined as having pDM if they had: (i) fasting plasma glucose concentration between 100 and 125 mg/dL; (ii) 2-h plasma glucose concentration in the 75 g oral glucose tolerance test from 140 mg/dL to 199 mg/dL (American Diabetes Association 2015). Hypogonadism was defined as total testosterone (tT) <3 ng/ml. Descriptive statistics and logistic regression models tested the odds (OR, 95%CI) of severe ED (IIEF-EF<11) after adjusting for age, BMI, CCI≥1, pDM, tT values and cigarette smoking status.
Results: Overall, pDM was found in 86 (23.1%) patients. Men with pDM had lower tT (p=0.04), higher triglycerides (p=0.005) and higher total cholesterol values (p=0.02) than those without pDM. Hypogonadism was more frequently reported by pDM+ men than those pDM- (34.3% vs. 22.3%; p=0.046). IIEF-EF domain score was lower in pDM+ than in pDM- patients (12.7 vs. 16.2; p=0.02). A higher rate of CCI≥1 (p=0.03) and a higher rate of severe ED (47.7% vs. 30.8%; p=0.013) were found in pDM+ than in pDM- patients. Multivariable logistic regression analysis showed that age (OR 1.02, p=0.014) and pDM+ (OR 2.03, p=0.021) achieved independent predictor status for severe ED, after accounting for BMI, CCI≥1, hypogonadal status and cigarette smoking.
Conclusions: One-out of five men seeking medical help for new onset ED showed glucose levels suggestive for pDM status. Men with pDM reported worse hormonal and metabolic profiles, along with a greater risk of severe ED compared to those pDM-. This finding stigmatizes the clinical relevance of a detailed metabolic and hormonal investigation in patients presenting with ED.
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