Etiologic aspects of impotence in diabetes

Dysfonction érectile et diabète : fréquence et profil clinique à partir de 200 observations

Objectif

la dysfonction érectile (DE) est une des complications les plus fréquentes du diabète mais également une des plus sous-diagnostiquées. Les auteurs rapportent la fréquence et le profil clinique de la DE dans une population de patients diabétiques.

Patients et méthodes

200 patients diabétiques ont été évalués par l’Index international de la fonction érectile 5 (IIEF5) dans sa traduction française.

Résultats

146 patients ont été inclus. Une DE était retrouvée chez 74 patients. Parmi eux, 21,6 % présentaient une forme sévère, 37,8 % une forme modérée et 40,6 % une forme mineure. Les patients présentant une DE étaient significativement plus âgés avec un diabète plus ancien.

Conclusion

la DE est fréquente et souvent sévère au cours du diabète. Le rôle des soignants est majeur pour détecter précocement ces troubles et ainsi mettre en place une prise en charge psychologique et médicamenteuse efficace, du moins lorsque cette dernière est matériellement possible.

Predictors for erectile dysfunction among diabetics

This study aims to examine the predictors related to erectile dysfunction (ED) among Chinese diabetics. From 1995 to 1999, 327 men with diabetes mellitus (DM) were enrolled into this study. They completed face to face interview, professional psychogenic assessment, measurements of penile hemodynamic parameters and measurements of hormone levels. Complications of diabetes were obtained from hospital medical records. One hundred and twenty nine diabetics were diagnosed as ED. The associations between individual predictor and ED were accessed using both univariate and multivariate logistic regression models. We found that the risk of ED was significantly associated with age (adjusted odd ratios (OR) = 1.16, 95% confident intervals (CI): 1.10-1.38), duration of DM (adjusted OR = 1.30, 95% CI: 1.28-1.87), lower physical activity (adjusted OR = 1.67, 95% CI: 1.15-3.03), retinopathy (adjusted OR = 1.15, 95% CI: 1.01-1.89), neuropathy (adjusted OR = 2.07, 95% CI: 1.54-3.06) and depression (adjusted OR = 1.46, 95% CI 1.32-2.56). The study shows that diabetics with ED suffer more serious complications than those patients with non-ED. ED may act as a sentinel event for underlying complications among male diabetics.

Erectile dysfunction in diabetic men: the neurological factor revisited

In the literature the importance of the neurological factor in the etiology of erectile dysfunction in patients with diabetes mellitus is subject to debate. We report on the findings of neurophysiological investigations in 27 impotent and 30 potent diabetic patients, as well as 102 impotent nondiabetic patients. Additionally, hormonal and vascular evaluations were done. The neurophysiological evaluations consisted of assessment of somatic as well as autonomic sensory nerves, by measuring the latencies of somatosensory evoked potentials of the posterior tibial and pudendal nerves, and of the bulbocavernosus and urethro-anal reflexes. The results show a higher incidence of more severe peripheral and autonomic sensory neuropathy in impotent diabetic men. Also, a preponderance of abnormal intracavernous pharmacological tests, suggesting vasculogenic impotence, was found in impotent diabetic patients. No important endocrinological differences were found among the 3 groups under investigation. Significant differences occurred for plasma glucose and glycosylated hemoglobin. We conclude that diabetic urogenital sensory neuropathy has a crucial role in the etiology of diabetic impotence. Angiopathy seems to be of secondary importance. The results show that poor diabetes regulation is associated with diabetic impotence.