Prevalence of erectile dysfunction among Egyptian male patients with type 2 diabetes mellitus

Autophagy in erectile dysfunction: focusing on apoptosis and fibrosis

In most types of erectile dysfunction, particularly in advanced stages, typical pathological features observed are reduced parenchymal cells coupled with increased tissue fibrosis. However, the current treatment methods have shown limited success in reversing these pathologic changes. Recent research has revealed that changes in autophagy levels, along with alterations in apoptosis and fibrosis-related proteins, are linked to the progression of erectile dysfunction, suggesting a significant association. Autophagy, known to significantly affect cell fate and tissue fibrosis, is currently being explored as a potential treatment modality for erectile dysfunction. However, these present studies are still in their nascent stage, and there are limited experimental data available. This review analyzes erectile dysfunction from a pathological perspective. It provides an in-depth overview of how autophagy is involved in the apoptotic processes of smooth muscle and endothelial cells and its role in the fibrotic processes occurring in the cavernosum. This study aimed to develop a theoretical framework for the potential effectiveness of autophagy in preventing and treating erectile dysfunction, thus encouraging further investigation among researchers in this area.

Association between erectile dysfunction and subjective well-being in primary care patients with type 2 diabetes

Objectives

To assess the association between erectile dysfunction and subjective well-being among primary care patients with type 2 diabetes mellitus.

Methods

This cross-sectional study included 340 men with type 2 diabetes treated in primary health care settings in the Ismailia governorate between April 2021 and April 2022. A multistage random cluster sampling technique was used. Sociodemographic data, disease characteristics, lifestyle, surgical and sexual history, and the Arabic translations of the abridged 5-item version of the International Index of Erectile Function (IIEF-5) Questionnaire, and the 5-item World Health Organization Well-Being Index (WHO-5) were gathered.

Results

Erectile dysfunction was identified in 72.94% of diabetic patients, with 55% mild or mild-to-moderate (ED I), and 17.9% moderate or severe (ED II). Twenty percent had Poor subjective well-being, with a mean WHO-5 index of 63.4 (± 15.4). Binary logistic regression analysis showed that education, diabetes duration, insufficient income, dyslipidemia, benign prostate hyperplasia, and IIEF-5 score were significantly associated with poor subjective well-being. Increasing IIEF-5 score was significantly associated with a 22% decrease in the odds of poor subjective well-being (OR: 0.78; 95% CI 0.66-0.93). Multinomial regression analysis showed that increasing score of the WHO-5 well-being index was associated with a 11% and 14% reduction in the odds of ED I and II, respectively (OR: 0.89 (95% CI 0.86-0.93), and 0.86 (95% CI 0.81-0.92), respectively).

Conclusion

Erectile dysfunction and subjective well-being were interrelated. Early detection of erectile dysfunction is essential for improving the positive mental health of men with type 2 diabetes in primary care.

The Associations between Kidney Function and Sexual Dysfunction among Males and Females with Type 2 Diabetes Mellitus

Background and Objectives: Diabetic kidney disease (DKD), expressed either as albuminuria, low estimated glomerular filtration rate (eGFR) or both, and sexual dysfunction (SD), are common complications among type 2 diabetes mellitus (T2DM) patients. This study aims to assess whether an association exists between DKD and SD, erectile dysfunction (ED) or female sexual dysfunction (FSD) in a T2DM population. Materials and Methods: A cross-sectional study was designed and conducted among T2DM patients. The presence of SD was assessed using the International Index of Erectile Function and the Female Sexual Function Index questionnaires for males and females, respectively, and patients were evaluated for DKD. Results: Overall, 80 patients, 50 males and 30 females, agreed to participate. Sexual dysfunction was present in 80% of the study population. Among the participants, 45% had DKD, 38.5% had albuminuria and/or proteinuria and 24.1% had an eGFR below 60 mL/min/1.73 m². The eGFR was associated with SD, ED and FSD. Moreover, SD and ED were proven as significant determinants for lower eGFR values in multiple linear regression analyses. DKD was associated with lower lubrication scores and eGFR was associated with lower desire, arousal, lubrication and total scores; however, the multivariate linear regression analyses showed no significant associations between them. Older age resulted in significantly lower arousal, lubrication, orgasm and total FSFI scores. Conclusions: SD is commonly encountered in older T2DM patients and DKD affects almost half of them. The eGFR has been significantly associated with SD, ED and FSD, while SD and ED were proven to be significant determinants for the eGFR levels.

Serum nesfatin-1 level in men with diabetes and erectile dysfunction correlates with generalized anxiety disorder-7: A prospective comparative study

BACKGROUND

Current studies have suggested a close link between nesfatin-1, an appetite-related neuropeptide and gonadal hormones.

OBJECTIVES

We investigated the association between nesfatin-1 serum level and erectile dysfunction severity in men with diabetes as well as the generalized anxiety disorder-7 questionnaire, the patient health questionnaire-9, serum testosterone, kidney and liver functions, glycated haemoglobin and lipid profile.

MATERIALS AND METHODS

Seventy-five participants between 30 and 60 years were enrolled, 25 erectile dysfunction patients with type 2 diabetes (group I), 21 with diabetes and preserved erectile function (group II) and 29 healthy controls (group III). Erectile dysfunction status and severity were determined by the Arabic version of the international index of erectile function-5 for all the participants. Psychological wellbeing was checked by the generalized anxiety disorder-7 questionnaire and the patient health questionnaire-9. Finally, participants were evaluated for serum nesfatin-1, serum testosterone, kidney and liver functions, glycated haemoglobin and lipid profile.

RESULTS

Serum nesfatin-1 levels were significantly lower in groups I and II compared to the controls. The international index of erectile function-5 scores had shown significant correlations with serum nesfatin-1, serum testosterone, generalized anxiety disorder-7, patient health questionnaire-9, diastolic blood pressure, glycated haemoglobin, triglycerides, creatinine and albumin/creatinine ratio. Receiver operating characteristic analysis revealed that serum nesfatin-1 ≥ 0.62 ng/ml, serum testosterone ≥2.9 ng/ml, generalized anxiety disorder-7 score ≥7.5, patient health questionnaire-9 score ≥5, glycated hemoglobin ≥6.4%, triglycerides ≥ 144 mg/dl, creatinine ≥ 0.85 mg/dl and albumin/creatinine ratio ≥ 26.5 are useful predictors of erectile dysfunction in men with type 2 diabetes, and the area under the curve for those variables was respectively 0.83, 0.76, 1, 0.75, 0.88, 0.72, 0.67 and 0.77. Finally, a linear regression analysis revealed that generalized anxiety disorder-7 was the only strong independent predictor of the international index of erectile function-5 (p < 0.001).

DISCUSSION AND CONCLUSION

Nesfatin-1 can be used as a biomarker for the severity of anxiety in erectile dysfunction patients with diabetes. Use of this molecule in treatment of diabetes and erectile dysfunction should be strengthened by larger studies. Psychiatric care must be offered to patients with diabetes and erectile dysfunction and low serum nesfatin-1 as they experience intense anxiety and depression.

Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville

INTRODUCTION

Erectile dysfunction (ED) is very common in diabetic males, especially type 2 diabetes mellitus (T2DM). Many factors and complications of diabetes such as macro- and micro-angiopathy are associated with risks leading to ED in male patients.

AIM

Analysis of factors associated with ED in T2DM. The purpose of this study is to shed light on potential associations between ED, type 2 diabetes, and some risks factors.

MATERIAL AND METHODS

This was a prospective analytic study of T2DM over 18. The study population consisted of diabetic patients seen at the endocrinology and urology departments of the University Hospital during the study period. Evaluation of ED was made by IIEF 5 score.

OUTCOMES

A total of 333 patients were selected for the study. The mean age was 56.6 ± 9.8 and the prevalence of ED was 82.6% (n = 275).

RESULTS

In univariate analysis, several associated factors were identified such as micro-angiopathic type complications including diabetic retinopathy (OR 4.88 [2.31-10.33], P < .001), diabetic nephropathy (OR 12.67 [1.71-93.66], P = .002) and macro-angiopathic type including arterial hypertension (OR 3.12 [1.69-5.75], P < .001). In multivariate analysis, duration of diabetes, micro and macroangiopathic complications, and hyperuricemia were independent risk factors for the occurrence of ED (P < .05).

CLINICAL IMPLICATIONS

The presence of certain complications of diabetes such as micro or macro angiopathy or hyperuricemia should lead to a search for a ED. The presence of these associated factors identified in type 2 diabetic patients should systematically prompt an ED diagnosis which is often moderate or severe. That diagnosis would help design a protocol for the management and improvement of the life quality of these patients.

STRENGTHS AND LIMITATIONS

The strength of this work is that it was conducted in the biggest hospital in the country which gives us a good idea of the trend of this ailment in the country. But the limitation of the study is that it only included patients who visited the hospital. This is monocentric hospital study was also transversal which does allow to establish a causal link.

CONCLUSION

ED has a significant prevalence in T2DM. Several associated factors identified in uni and multivariate analyses, including duration of diabetes, micro and macro angiopathic complications, and hyperuricemia, increase ED risk. Therefore, it is essential to investigate the existence of these factors to improve the management of ED, which may allow the patient to regain a better overall health status. SNN Milama, A Mougougou, S G Olagui, et al. Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville. Sex Med 2022;10:100564.