Unrecognized Prediabetes Is Highly Prevalent in Men With Erectile Dysfunction–Results From a Cross-Sectional Study

Erectile dysfunction as a predictive indicator of asymptomatic diabetes and prediabetes

AIMS

Both erectile dysfunction (ED) and diabetes (DM) are common health problems that share risk factors. The aim of this study was to investigate whether ED can predict glucose metabolism dysfunctions in men at the primary care level.

METHODS

An 11-year population-based cohort study was conducted in men born between 1933 and 1956. The baseline survey was conducted in 2007-2008, with a follow-up examination 11 years later. The International Index of Erectile Function (IIEF-5) questionnaire was used to assess erectile function. Dysglycemia was evaluated using and a 2-hour oral glucose tolerance test (2hOGTT), in combination with health registry data.

RESULTS

At baseline, men with ED but without a history of known DM exhibited a significantly higher prevalence of undetected DM, odds ratio (OR) 4.7 (95 % CI 1.6, 14.4), and preDM, OR 1.9 (1.1, 3.2), compared with men without ED. Over an 11-year follow-up period, a significantly increased cumulative incidence of DM was observed in men who reported symptoms of ED at the start of the study.

CONCLUSIONS

The symptoms of ED appear to be an early warning sign of existing DM and preDM and predict an increased risk of developing abnormal glucose metabolism in the future.

Platelet-rich plasma intracavernosal injections for the treatment of primary organic erectile dysfunction: a systematic review and meta-analysis of contemporary controlled studies

We aim to summarize the latest evidence on platelet-rich plasma (PRP) intracavernosal injections efficacy in men affected by primary organic erectile dysfunction (ED). We reviewed the literature for randomized controlled trials (RCTs) or prospective and retrospective comparative studies evaluating PRP alone or in combination for ED treatment. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language full-text articles or conference abstracts. A qualitative and quantitative data synthesis was provided. Overall, seven records were included: three RCTs evaluated PRP vs. placebo, one study separately tested PRP and low-intensity shock wave therapy (Li-SWT), three studies compared Li-SWT or low-intensity pulsed ultrasound alone with their combination with PRP. Of 641 included patients, 320 received PRP. Despite the heterogeneity among inclusion criteria, dose and protocol of PRP administration, and outcomes measured, most studies independently reported better sexual outcomes in patients who received PRP, without significant severe side effects. In meta-analysis, where only placebo-controlled studies were included, patients treated with PRP showed higher International Index of Erectile Function (erectile function domain) score compared to patients who received placebo: pooled mean difference (95% Confidence Interval) of 2.99 (1.86, 4.13) after 1 month (209 patients) vs. 2.85 (1.61, 4.09) after 3 months (204 patients) vs. 3.21 (1.82, 4.60) after 6 months (199 patients) of follow-up. In men affected by primary organic ED, PRP intracavernosal injections demonstrated an objective improvement or at least a tendency in erectile function recovery. Patient numbers, and the short-term follow-up may limit the generalizability of these observations. High quality, large-scale, and standardized controlled trials are needed before recommending its definitive use in clinical practice.

Nesfatin-1 regulates the phenotype transition of cavernous smooth muscle cells by activating PI3K/AKT/mTOR signaling pathway to improve diabetic erectile dysfunction

Objective

This study aims to explore the impact of Nesfatin-1 on type 2 diabetic erectile dysfunction (T2DMED) and its underlying mechanism in regulating the phenotypic switching of corpus cavernosum smooth muscle cells (CCSMCs).

Methods

Twenty-four 4-week-old male C57 wild-type mice were randomly assigned to the control group, model group, and Nesfatin-1 treatment group. Monitoring included body weight, blood glucose levels, and penile cavernous pressure (ICP). Histochemistry and Western blot analyses were conducted to assess the expressions of α-SMA, OPN, and factors related to the PI3K/AKT/mTOR signaling pathway. CCSMCs were categorized into the control group, high glucose and high oleic acid group (GO group), Nesfatin-1 treatment group (GO + N group), sildenafil positive control group (GO + S group), and PI3K inhibitor group (GO + N + E group). Changes in phenotypic markers, cell morphology, and the PI3K/AKT/mTOR signaling pathway were observed in each group.

Results

(1) Nesfatin-1 significantly ameliorated the body size, body weight, blood glucose, glucose tolerance, and insulin resistance in T2DMED mice. (2) Following Nesfatin-1 treatment, the ICP/MSBP ratio and the peak of the ICP curve demonstrated a significant increase. (3) Nesfatin-1 significantly enhanced smooth muscle and reduced collagen fibers in the corpus cavernosum. (4) Nesfatin-1 notably increased α-SMA expression and decreased OPN expression in CCSMCs. (5) Nesfatin-1 elevated PI3K, p-AKT/AKT, and p-mTOR/mTOR levels in penile cavernous tissue.

Conclusions

Nesfatin-1 not only effectively improves body weight and blood glucose levels in diabetic mice but also enhances erectile function and regulates the phenotypic switching of corpus cavernosum smooth muscle. The potential mechanism involves Nesfatin-1 activating the PI3K/AKT/mTOR signaling pathway to induce the conversion of CCSMCs to a contractile phenotype.

Kidney function impairment in men with primary infertility: A case-control analysis

BACKGROUND

Infertile men have a worse overall health status than their fertile counterparts.

OBJECTIVE

We aimed to (1) compare kidney function in men presenting for primary couple's infertility with that of fertile men and (2) assess kidney function impairment toward sperm quality in infertile men.

MATERIALS AND METHODS

In this case-control study, 387 consecutive white-European infertile men were matched by age with 134 same-ethnicity fertile men. Complete clinical and laboratory data were available for each patient. The Chronic Kidney Disease Epidemiology Collaboration function was used for estimated glomerular filtration rate calculation. Kidney functional impairment was defined as an estimated glomerular filtration rate <90 mL/min per 1.73 m2 , according to the Kidney Disease Improving Global Outcomes criteria. Multivariable logistic regression analysis was used to (1) assess the association between kidney function impairment and infertility status and (2) investigate the association between kidney function and semen analysis abnormalities in infertile men.

RESULTS

After matching, 34 (8.8%) infertile men depicted at least a mild unknown impairment of kidney function compared to only four (3%) fertile men, with four (3%) of the infertile presenting with an overt kidney function impairment (estimated glomerular filtration rate <60 mL/min per 1.73 m2 ). There were no differences in terms of age, body mass index and rate of comorbidities between the two groups (all p > 0.05). After adjusting for major confounders, infertility status was associated with a higher risk of reduced estimated glomerular filtration rate (odds ratio 3.20; 95% confidence interval 1.21-5.2; p = 0.002). Conversely, estimated glomerular filtration rate was not associated with sperm abnormalities in infertile men.

CONCLUSIONS

Mild kidney function impairment was found in 9% of asymptomatic and unaware men presenting for primary couple's infertility investigation. This novel finding corroborates growing data on a significant association of male infertility with a poorer overall male health status and the need for tailored preventive strategies.

Erectile dysfunction associated with undiagnosed prediabetes and type 2 diabetes in young adult males: A retrospective cohort study

Erectile dysfunction (ED) is a common comorbidity in type 2 diabetes (T2D). ED has been studied as an outcome in diabetes, but it is not known if ED is a risk factor for T2D. We determined if patients with ED have an increased risk for prediabetes and/or T2D and measured the duration between ED and prediabetes/T2D diagnosis. Retrospective cohort study using de-identified medical record data from a large mid-western health care system to measure ED, T2D and potential confounding factors. Patients were 18 to 40 years of age because we were interested in early onset pre-diabetes/T2D. Eligible patients had ED and were free of prediabetes, hyperglycemia and T2D at index. Entropy balancing controlled for confounding. Modified Poisson regression models with robust error variances calculated relative risk (RR) and 95% confidence intervals for the association of ED and pre-diabetes/T2D. Patients' mean age was 28.3 (±7.0) years, 81.7% were White and 14.0% were Black. After controlling for confounding, ED was associated with increased risk for prediabetes/T2D (RR = 1.34; 95%CI:1.16-1.55). This association was similar to that between ED and T2D alone (RR = 1.38; 95% CI: 1.10-1.74). About 30% had ED and prediabetes/T2D diagnosed on the same day and nearly 75% were diagnosed within a year of ED. ED is a marker for undiagnosed prediabetes/T2D and a risk factor for near term onset of prediabetes/T2D. ED may offer the opportunity for earlier detection and diagnoses of T2D, particularly in younger men. Younger patients presenting with ED should be screened for hyperglycemia.

Gaps in the management of diabetes in Asia: A need for improved awareness and strategies in men's sexual health

Sexual dysfunction, which is defined as 'difficulty during any stage of the sexual encounter that prevents or impairs the individual or couple from enjoying sexual activity', is globally prevalent in males with prediabetes and diabetes. It is an early harbinger of cardiovascular diseases and has a profound impact on one's physical, mental, and social health. Among patients with either prediabetes or diabetes, the most common male sexual dysfunctions are hypogonadism, erectile dysfunction, and premature ejaculation. In Asia, although sexual health is an important factor of men's health, it is rarely discussed freely in real-life practice. Addressing sexual health in Asian males has always been challenging with multiple barriers at the levels of patients and health care providers. Therefore, the assessment and management of sexual dysfunction in routine clinical practice should involve a holistic approach with effective patient-provider communication. In this review, we discuss the epidemiology, pathophysiology, and the management of hypogonadism, erectile dysfunction, and premature ejaculation among males with either prediabetes or diabetes (type 1 and type 2), as well as the evidence gaps across Asia.

Sexual Dysfunction in Men and Women with Diabetes: A Reflection of their Complications?

BACKGROUND

Diabetes mellitus (DM), one of the worldwide leading causes of death, is associated with a plethora of micro- and macro-vascular complications which should be carefully investigated and, in case, treated in order to improve quality of life and reduce the risk of premature mortality.

OBJECTIVE

The study aimed to investigate and report current evidence with regard to the association between sexual dysfunction and diabetes.

METHODS

A detailed analysis of current literature has been performed on PubMed and Scholar in order to retrieve the most relevant findings pertaining to the study topic.

RESULTS

Female and male sexual dysfunction often occurs in diabetes; while cardiovascular complications are clearly involved, psychosexological factors, endocrine complications, and endothelial dysfunction all contribute to the pathogenesis of sexual dysfunctions. Psychological symptoms are seldom investigated, yet they should not be overlooked by the clinician; in fact, an interplay between sexual dysfunctions and depressive symptoms has been reported, and beneficial effects in both conditions might be obtained by adequate psychological support. Sexual dysfunctions can also act as early biomarkers of cardiovascular disease, a phenomenon frequently reported in men, in which erectile dysfunction predicts the development of coronary artery disease. Additionally, drug therapies can act in both directions, with treatments for diabetes possibly improving male sexual function and exerting beneficial effects for cardiovascular health being reported for pro-erectile drugs.

CONCLUSION

Sexual dysfunctions often occur in men and women with diabetes. Investigating micro- and macro-vascular complications might not be enough to prevent the development or worsening of any sexual dysfunction; endocrine and psychological assessments are therefore needed to provide the best chances for adequate treatment.

A Meta-Analysis of Erectile Dysfunction and Alcohol Consumption

PURPOSE

The purpose of the study was to evaluate the association between alcohol consumption and risk of erectile dysfunction (ED).

METHODS

PubMed was searched for reports published before June 2019. Data were extracted and combined odds ratios (ORs) calculated with random-effects models.

RESULTS

Finally, 46 studies were included (216,461 participants). The results of our meta-analysis indicated that there was a significant association between regular alcohol consumption and ED (OR 0.89, 95% confidence interval [CI]: 0.81-0.97). There was no indication of publication bias (Egger's test, p = 0.37). In the stratified analysis, the pooled OR of ED for light to moderate and high alcohol consumption was 0.82 (95% CI: 0.72-0.94) and 0.82 (95% CI: 0.67-1.00), respectively. No variable related to the source of heterogeneity was found in univariate and multivariate meta-regression analyses. A dose-response meta-analysis suggested that a nonlinear relationship between alcohol consumption and risk of ED was observed (p for nonlinearity <0.001).

CONCLUSION

A J-shaped relationship between alcohol consumption and risk of ED was observed. Alcohol should be taken in moderate quantities in order to obtain the dual effect of disinhibition and relaxation. If taken chronically, it could provoke vascular damages.

Increase in testosterone levels is related to a lower risk of conversion of prediabetes to manifest diabetes in prediabetic males

Background

Testosterone plays an important role in the regulation of glucose metabolism. While earlier studies have shown that it has a protective effect in males, unfavorable effects of testosterone on glucose metabolism have been reported in females; however, whether there is a sex-specific relationship between testosterone and glucose metabolism in patients with prediabetes has not been investigated in detail hitherto.

Methods

This cross-sectional analysis investigated 423 males and 287 females with diagnosed prediabetes. Detailed assessment of their metabolic profiles was performed, including a 2‑h oral glucose tolerance test (OGTT), HbA1c levels, calculation of insulin resistance with homeostatic model assessment for insulin resistance (HOMA-IR), assessment of lipid metabolism, anthropometric parameters and the fatty liver index (FLI). By using Spearman’s correlation test, we investigated the sex-specific relationship between testosterone and metabolism in the prediabetic individuals.

Results

In the present study, prediabetic females (mean age 58.6 years, confidence interval [CI: 57.6 y; 59.5 y]) were characterized by lower fasting plasma glucose levels (104.2 mg/dl [CI: 103.0 mg/dl; 105.4 mg/dl] vs. 106.9 mg/dl [CI: 106.0 mg/dl; 107.8 mg/dl]) and a lower FLI (49.5 [CI: 45.7; 53.2] vs. 58.8 [CI: 55.8; 61.8]), but presented with a higher risk of developing manifest type 2 diabetes in the next 10 years (FINDRISK score: 17.6 [CI: 17.1; 18.1] vs. 16.1 [CI: 15.7; 16.5]) when compared to prediabetic males (mean age: 58.04 years [CI: 57.0 y; 59.1 y]). Testosterone was negatively related to insulin resistance (HOMA-IR: Spearman’s ρ: −0.33, p < 0.01), 2‑h stimulated glucose levels during the OGTT (ρ = −0.18, p < 0.01), HbA1c levels (ρ = −0.13, p < 0.05), FLI and BMI in prediabetic males; however, no relationship between testosterone and metabolic parameters could be found in prediabetic females.

Conclusion

The increase of testosterone levels in males was related to a more favorable glucose metabolism, including lower HbA1c, lower stimulated glucose levels and higher insulin sensitivity; however, in prediabetic females, testosterone was not related to glucose metabolism.

Association Between Prediabetes and Erectile Dysfunction: A Meta-Analysis

BACKGROUND

Diabetes has been associated with the increased risk of erectile dysfunction (ED). However, previous studies evaluating the association between prediabetes and ED showed inconsistent results. We performed a meta-analysis of observational studies to systematically evaluate the above association.

METHODS

Relevant observational studies were retrieved by search of PubMed, Embase, and Web of Science databases. A random-effect model which incorporated the potential intra-study heterogeneity was used for the meta-analysis. Subgroup analyses were performed to evaluate the influences of study characteristics on the outcome.

RESULTS

Nine studies (five matched case-control studies and four cross-sectional studies) were included. Age were adjusted or matched in all of the studies. Pooled results showed that compared to men with normoglycemia, men with prediabetes were associated with higher prevalence of ED (odds ratio = 1.62, 95% confidence interval: 1.28 to 2.07, P < 0.001; I² = 78%). Subgroup analyses showed that the association was not significantly affected by definition of prediabetes, diagnostic tool for ED, or controlling of additional variables besides age (both P for subgroup difference > 0.05). However, the association between prediabetes and ED seemed to be stronger in case-control studies than that in cross-sectional studies, and in studies with younger men (mean age < 50 years) than in those with older men (mean age ≥ 50 years; both P for subgroup difference < 0.05).

CONCLUSIONS

Prediabetes is associated with higher prevalence of ED, which may be independent of age of the males and may be stronger in young men.

Triglyceride-Glucose Index (TyG) is associated with erectile dysfunction: A cross-sectional study

BACKGROUND

Erectile dysfunction (ED) is often associated with endocrine metabolic diseases such as metabolic syndrome (MetS) and diabetes mellitus (DM), in which insulin resistance (IR) plays a decisive role in pathology. Triglyceride-glucose index (TyG), a simple, inexpensive and easily accessible IR marker, is calculated by fasting serum glucose and triglyceride values.

OBJECTIVES

We aimed to reveal the relationship between TyG index and ED.

MATERIALS AND METHODS

Of 152 male patients, aged between 24-80 years, admitted to the urology outpatient clinic with complaining erectile insufficiency were evaluated. Liver function tests, complete blood count, fasting serum triglyceride, serum testosterone, fasting glucose, fasting insulin, and hemoglobinA1c (HbA1c) were analyzed. TyG index was calculated. All patients were requested to fill in the validated Turkish version of the 5-item International Index of Erectile Function (IIEF-5) survey.

RESULTS

A total of 142 patients were included the study. ED was detected in 91 (64.1%) of the patients. BMI, fasting insulin level, fasting glucose level, IR, GGT, HDL, HbA1c, Triglyceride, TyG, DM, HT, and MetS status of the patients in ED group were statistically significantly higher compared to non-ED group (all P < .05). It was found that the cutoff value of TyG index for ED was 8.88 (AUC = 0.739, sensitivity 67%, specificity = 68.6%). In multivariate logistic regression analysis, age (OR = 1.07, 95% CI = 1026-1115, P = .002) and TyG index above 8.88 (OR = 3.865, 95% CI = 1686-8859, P = .001) were found as independent predictors of ED after accounting for BMI, serum total T and IR.

CONCLUSION

TyG index might be useful in the diagnosis and follow-up of ED.

Undiagnosed prediabetes status is associated with a reduced effectiveness of phosphodiesterase type 5 inhibitors in men with erectile dysfunction

The efficacy of phosphodiesterase type 5 inhibitors (PDE5i) in patients with erectile dysfunction (ED) and undiagnosed prediabetes (PreDM) has been scantly analysed. We aimed to assess rates of and predictors of response to oral treatment in a cohort of ED men naïve for PDE5i with either normo-glycaemia or PreDM or diabetes mellitus (DM). Complete data from 466 men were analysed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF) at baseline and after 3 months of PDE5i treatment. Treatment response was evaluated using the minimal clinically important difference (MCID) (mild: +2; moderate: +5; severe: +7 from baseline IIEF-EF). PreDM status was defined as for the American Diabetes Association (2015) criteria. Descriptive statistics and logistic regression models tested the association between clinical predictors and MCID response. Overall, 253 (56.7%), 105 (23.5%) and 88 (19.7%) patients had normo-glycaemia (=controls), PreDM and DM, respectively. Diabetic and PreDM men were older, had higher BMI, higher CCI scores and lower total testosterone (tT) (all p < 0.01) compared to controls. Median baseline IIEF-EF was lower both in PreDM (14.0 vs. 18.0; p < 0.05) and DM patients (10.0 vs. 18.0; p < 0.001) than in controls. IIEF-EF improved in all groups after treatment (all p < 0.001), but scores were higher in controls compared to both PreDM and DM men at 3-mos assessment (26.0 vs. 20.0 vs. 17.5, respectively; all p < 0.001). Controls more frequently achieved significant MCID than both PreDM and DM patients (65.3 vs. 22.9 vs. 11.8%, respectively; p < 0.01). Age (p < 0.001), baseline IIEF-EF (p < 0.001), and DM status (p = 0.02) were independently associated with MCID. In conclusion, patients with undiagnosed PreDM depicted lower rates of response to PDE5i than normoglycemic men. These findings suggest that even milder forms of glucose impairment are associated with a poorer PDE5i effectiveness in men with ED.