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Fan J, Peng T, Hui J, Ding W, He B, Zhang H, Wei A. Erectile Dysfunction in Type-2 Diabetes Mellitus Patients: Predictors of Early Detection and Treatment. Urol Int 2021; 105:986-992. [PMID: 33951654 DOI: 10.1159/000514700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To identify risk factors and potential predictors of erectile dysfunction (ED) in type-2 diabetes mellitus (T2DM) patients for early detection and treatment. METHODS A retrospective cohort was used to assess the clinical data of 105 diabetic patients with ED from May 2019 to April 2020 age-matched to 105 diabetic patients without ED. Potential risk factors that could contribute to ED were compared between the groups. Erectile function was evaluated using the International Index of Erectile Function-5 questionnaire. RESULTS There were higher rates of diabetic peripheral neuropathy (p = 0.036) and retinopathy (p < 0.001), longer duration of diabetes (p < 0.001), lower estimated glomerular filtration rate (p = 0.010) values, and higher uric acid (p < 0.001) and C-reactive protein (p = 0.001) levels in the ED group compared to the non-ED group. Multivariate logistic analysis identified uric acid, diabetic retinopathy, and T2DM course as independent predictors of diabetic ED. Diabetics with retinopathy and T2DM for ≥49 months were 3.028 and 3.860 times more likely to have ED, respectively. Uric acid values ≥392.5 μmol/L were associated with 18.638 times greater risk of having ED, though the values were within normal range. CONCLUSION In T2DM patients, higher uric acid (≥392.5 μmol/L), longer diabetes duration (≥49 months), and the presence of diabetic retinopathy were important and reliable predictors for diabetic ED. For patients who have high risk factors for developing ED, diligent screening and early treatment are necessary.
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Affiliation(s)
- Junhong Fan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tianwen Peng
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jialiang Hui
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei Ding
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Urology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Binglin He
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haibo Zhang
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Anyang Wei
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Kamal EE, Ali MEM, Mohamed MZ, Soliman M, El-Mahdy RI, Elsayed A, Badran AY. Relation of pharmacopenile duplex ultrasonography parameters and glycated hemoglobin (HbA1c) in diabetic patients with erectile dysfunction. Rev Int Androl 2020; 20:31-40. [PMID: 33334711 DOI: 10.1016/j.androl.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/22/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Erectile dysfunction (ED) is one of the main threats in diabetic patients. This research aimed to assess the relationship between glycated hemoglobin (HbA1c) level and pharmacopenile duplex ultrasonography (PPDU) indices in diabetic patients with ED. MATERIALS AND METHODS A total of 130 males with ED were recruited (100 had diabetes mellitus (DM) and 30 did not as control). The International Index of Erectile Function (IIEF) was used to evaluate patients for ED. Measurement of HbA1c, lipid profile and assessment of erectile function using PPDU were performed. All participants were assessed to take the medical history. RESULTS The mean age±SD was 53.8±8.9 and 53.6±2.8 years for patients and controls, respectively. Patients had variable grades of ED: mild in 20%, mild to moderate in 32.3%, moderate in 35.3%, and severe in 12.3%. A significant association was found between the existence of DM and a deprived response to intracorporeal injection (ICI), rising end-diastolic velocity (EDV), and reducing resistance index (RI) values. Comparing all diabetic groups according to HbA1c with controls, a significant relationship was found in; severity of IIEF-5 score, poor response to ICI, decreased peak systolic velocity (PSV) at 10min, increased EDV at 10, 20min and decreased RI at 10, 20min. A significant relationship was found between smoking, dyslipidaemia, and decreased PSV at 10, 20min and decreased increment ratio. However, a non-significant relationship was observed between age, type of DM and PPDU parameters. CONCLUSION Poor glycaemic control of DM is associated with an increase in EDV and decrease in RI, and PSV of PPDU.
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Affiliation(s)
- Emad Eldien Kamal
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
| | - Mohammed Essam M Ali
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
| | | | - Mona Soliman
- Department of Internal medicine and endocrinology, Faculty of Medicine, Assiut University, Egypt
| | - Reham I El-Mahdy
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Egypt.
| | - Ahmed Elsayed
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
| | - Aya Y Badran
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
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Liao ZC, Li XC, Tang YX, Li DJ, Tang ZY. Is milder psychological stress responsible for more severe erectile dysfunction? Andrologia 2020; 52:e13550. [PMID: 32149423 DOI: 10.1111/and.13550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
China is a sexually conservative country compared with Western countries. To evaluate the psychological characteristics of Chinese erectile dysfunction (ED) patients, we conducted a cross-sectional study of 153 ED outpatients. Patients were interviewed with the Structured Interview on Erectile Dysfunction (SIEDY) for pathogenic quantification. ED was measured by International Index of Erectile Function (IIEF). Depression and anxiety were evaluated with 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalised Anxiety Disorder Scale (GAD-7) respectively. Most patients (74.5%) were <40 years old. IIEF-5 were significantly correlated with SIEDY scale 3 (r = .16, p = .040) and GAD-7 (p = .15, p = .033). The SIEDY scale 1 increased with age, but the IIEF-5, SIEDY scale 3, PHQ-9 and GAD-7 decreased with age. A negative correlation was observed between ED and psychological stress, which conflicts with many Western-country studies. Younger patients were characterised by milder ED but more psychological stress, while older patients were characterised by worse ED but less psychological stress. Which may be responsible for the conflicting result. Meanwhile, the much younger age distribution among Chinese ED outpatients may indicate that quite a few older ED patients (≥40 years) in China do not seek outpatient service which should merit more attention.
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Affiliation(s)
- Zhang-Cheng Liao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiu-Cheng Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu-Xin Tang
- Department of Urology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Dong-Jie Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China.,Department of Geriatric urology, Xiangya International Medical Center, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Changsha, China
| | - Zheng-Yan Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, China
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Wang X, Yang X, Cai Y, Wang S, Weng W. High Prevalence of Erectile Dysfunction in Diabetic Men With Depressive Symptoms: A Meta-Analysis. J Sex Med 2018; 15:935-941. [DOI: 10.1016/j.jsxm.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 01/11/2023]
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Chilelli NC, Bax G, Bonaldo G, Ragazzi E, Iafrate M, Zattoni F, Bellavere F, Lapolla A. Lower urinary tract symptoms (LUTS) in males with type 2 diabetes recently treated with SGLT2 inhibitors-overlooked and overwhelming? A retrospective case series. Endocrine 2018; 59:690-693. [PMID: 28421418 DOI: 10.1007/s12020-017-1301-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | - Giuseppe Bax
- Diabetology and Dietetics Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Giulio Bonaldo
- Urology Clinic, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Massimo Iafrate
- Urology Clinic, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy
| | - Filiberto Zattoni
- Urology Clinic, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy
| | | | - Annunziata Lapolla
- Diabetology and Dietetics Unit, Department of Medicine, University of Padova, Padova, Italy.
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De Nunzio C, Roehrborn CG, Andersson KE, McVary KT. Erectile Dysfunction and Lower Urinary Tract Symptoms. Eur Urol Focus 2017; 3:352-363. [PMID: 29191671 DOI: 10.1016/j.euf.2017.11.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/12/2017] [Accepted: 11/13/2017] [Indexed: 01/10/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTSs) and erectile dysfunction (ED) are substantial health concerns with a significant impact on the overall male quality of life. OBJECTIVE To evaluate the available evidence of the association between LUTSs and ED in patients with benign prostatic hyperplasia (BPH), and discuss possible clinical implications for the management of LUTS/BPH. EVIDENCE ACQUISITION A systematic review of the existing literature published between 1997 and June 2017 and available in the Medline, Scopus, and Web of Science databases was conducted using both the Medical Subject Heading (MeSH) and free-text protocols. The MeSH search was conducted by combining the following terms: "lower urinary tract symptoms," "LUTS," "benign prostatic hyperplasia," "BPH," "erectile dysfunction," "sexual dysfunction," "BPE," and "benign prostatic enlargement." The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. EVIDENCE SYNTHESIS Several community-based studies in different geographical areas have provided strong evidence of an age-independent association between LUTSs and ED. Several biological mechanisms have been proposed to explain this association, but further research is required to better understand the molecular pathways involved. It is necessary to evaluate the possible impact of the metabolic syndrome treatment on LUTS/ED management. Considering the possible relationship between LUTSs and ED, their impact on the quality of life, and the possible adverse effects associated with LUTS medical treatment, clinicians should always evaluate ED in patients with LUTSs and take the opportunity to evaluate patients reporting ED for LUTSs. CONCLUSIONS Data from the peer-reviewed literature suggest the existence of an association between LUTS/BPH and ED, although their casual relationship has not been established yet. Emerging data also suggest that pathophysiological mechanisms involved in the metabolic syndrome are key factors in both disorders. Considering the association, it is also recommended that men presenting with LUTSs or ED should be evaluated for both disorders. A better understanding of the molecular pathways behind this association may also help identify new possible targets and develop novel therapeutic approaches to manage LUTSs and ED. PATIENT SUMMARY In this manuscript, we report on all the available evidence linking erectile dysfunction and lower urinary tract symptoms. Our findings suggest the existence of a strong relationship between these two conditions. On the basis of these findings, we recommend that clinicians always explore both conditions in male patients presenting with either of symptoms.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, "La Sapienza" University, Roma, Italy.
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kevin T McVary
- Southern Illinois University School of Medicine, Springfield, IL, USA
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Alcántara Montero A. Sodium glucose cotransporter 2 inhibitors and males lower urinary tract symptoms, an aspect to consider. Actas Urol Esp 2017; 41:602. [PMID: 28666607 DOI: 10.1016/j.acuro.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 11/17/2022]
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Depressive symptoms and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: the Dogo Study. Int J Impot Res 2016; 29:57-60. [PMID: 27853168 DOI: 10.1038/ijir.2016.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/29/2016] [Accepted: 10/16/2016] [Indexed: 12/17/2022]
Abstract
In several studies of patients with type 2 diabetes mellitus, a positive association between depressive symptoms and erectile dysfunction (ED) has been reported. No evidence exists, however, regarding the association between depressive symptoms and ED among Japanese patients with type 2 diabetes mellitus. Thus, we examined this issue among Japanese patients with type 2 diabetes mellitus. Study subjects were 469 male Japanese patients with type 2 diabetes mellitus, aged 19 years or over. ED, moderate to severe ED and severe ED were defined as present when a subject had a Sexual Health Inventory for Men score <22, <12 and <8, respectively. Depressive symptoms were defined as present when a subject had a Self-Rating Depression Scale (SDS) score >49. Adjustment was made for age, body mass index, waist, duration of type 2 diabetes, current smoking, current drinking, hypertension, dyslipidemia, coronary artery disease, stroke, glycated hemoglobin and diabetic neuropathy. The prevalence values of depressive symptoms, moderate to severe ED and severe ED were 15.1%, 64.2% and 51.0%, respectively. Depressive symptoms were independently positively associated with moderate to severe ED and severe ED (adjusted odds ratios were 2.23 (95% confidence interval (CI): 1.17-4.43) and 1.86 (95% CI: 1.04-3.41), respectively). In Japanese patients with type 2 diabetes mellitus, depressive symptoms may be associated with ED.
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An association between diet, metabolic syndrome and lower urinary tract symptoms. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Capon G, Caremel R, de Sèze M, Even A, Fontaine S, Loche CM, Bart S, Castel-Lacanal E, Duchêne F, Karsenty G, Mouracade P, Perrouin-Verbe MA, Phé V, Rey D, Scheiber-Nogueira MC, Gamé X. [The impact of mellitus diabetes on the lower urinary tract: A review of Neuro-urology Committee of the French Association of Urology]. Prog Urol 2015; 26:245-53. [PMID: 26452712 DOI: 10.1016/j.purol.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Specify urinary functional impairment associated with diabetic pathology. Propose guidance for screening, monitoring of clinical signs of lower urinary tract (LUTS) and describe the specifics of the urological treatment of patients. METHODS A review of literature using PubMed library was performed using the following keywords alone or in combination: "diabetes mellitus", "diabetic cystopathy", "overactive bladder", "bladder dysfunction", "urodynamics", "nocturia". RESULTS LUTS are more common in the diabetic population with an estimated prevalence between 37 and 70 %, and are probably underevaluated in routine practice. They are heterogeneous and are frequently associated with other diabetic complications. Both storage and voiding symptoms can coexist. Despite a major evaluation in the literature, no recommendation supervises the assessment and management of LUTS in this specific population. An annual screening including medical history, bladder and kidney ultrasound and post-void residual measurement is required in the follow-up of diabetic patients. Specific urologial referral and urodynamic investigations will be performed according to the findings of first-line investigations. The type of bladder dysfunction, the risk of urinary tract infections and dysautonomia should be considered in the specific urological management of these patients. CONCLUSION Diabetes mellitus significantly impacts on the lower urinary tract function. A screening of LUTS is required as well as other complications of diabetes. The management of LUTS must take into consideration the specific risks of the diabetic patient regarding the loss of bladder contractility, the possibility of dysautonomia and infectious complications.
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Affiliation(s)
- G Capon
- Service d'urologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
| | - R Caremel
- Service d'urologie, hôpital Charles-Nicolle, 76000 Rouen, France
| | - M de Sèze
- Cabinet de neuro-urologie, urodynamique et pelvipérinéologie, clinique Saint-Augustin, 33000 Bordeaux, France
| | - A Even
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, 92340 Garches, France
| | - S Fontaine
- Service de médecine interne, endocrinologie, diabète, nutrition, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - C-M Loche
- Service de rééducation neurolocomotrice, CHU Henri-Mondor, AP-HP, 94010 Créteil, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, 95300 Cergy-Pontoise, France
| | - E Castel-Lacanal
- Service de médecine physique et réadaptation, CHU Rangueil, 31400 Toulouse, France
| | - F Duchêne
- Service d'urologie, clinique de l'Alliance, 37540 Saint-Cyr-sur-Loire, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de la Conception, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - P Mouracade
- Service d'urologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - M-A Perrouin-Verbe
- Service d'urologie, hôpital de la Cavale-Blanche, CHU de Brest, 29609 Brest, France
| | - V Phé
- Service d'urologie, hôpital de la Pitié-Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - D Rey
- Clinique Saint-Augustin, 33000 Bordeaux, France
| | - M-C Scheiber-Nogueira
- Services d'urologie et d'explorations neurologiques, CHU Lyon Sud, 69495 Pierre-Bénite, France
| | - X Gamé
- Service d'urologie, CHU Rangueil, 31400 Toulouse, France
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Jacobson AM, Braffett BH, Cleary PA, Dunn RL, Larkin ME, Wessells H, Sarma AV. Relationship of urologic complications with health-related quality of life and perceived value of health in men and women with type 1 diabetes: the Diabetes Control and Complications Trial/Epidemiology of Interventions and Complications (DCCT/EDIC) cohort. Diabetes Care 2015. [PMID: 26203062 PMCID: PMC4580606 DOI: 10.2337/dc15-0286] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Limited information exists about the influence of urologic complications on health-related quality of life (HRQOL) in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS We studied 664 men and 580 women from the Diabetes Control and Complications Trial/Epidemiology of Interventions and Complications Study: mean ages were 51.6 ± 6.6 and 50.6 ± 7.2 years and duration of diabetes was 29.5 ± 4.8 and 29.8 ± 5.1 years, respectively. We assessed associations of sexual dysfunction, lower urinary tract symptoms (LUTS), and, in women, urinary incontinence (UI) with general quality of life (SF-36), perceived value of health (EuroQol-5), diabetes-related quality of life (Diabetes Quality of Life Scale [DQOL]), and psychiatric symptoms (Symptom Checklist 90-R). RESULTS In both men and women, urologic complications adversely affected HRQOL and psychiatric symptoms, even after accounting for history of depression leading to treatment. Multivariable analyses accounting for the presence of diabetic retinopathy, neuropathy, and nephropathy also revealed substantial independent effects. In men, for example, the odds (95% CI) of a low DQOL score (≤25th percentile) were 3.01 (1.90-4.75) times greater with erectile dysfunction and 2.65 (1.68-4.18) times greater with LUTS and in women, 2.04 (1.25-3.35) times greater with sexual dysfunction and 2.71 (1.72-4.27) times greater with UI/LUTS combined compared with men and women without such complications. Similar effects were observed for the other measures. CONCLUSIONS Sexual dysfunction and urinary complications with type 1 diabetes are associated with decreased quality of life and perceived value of health and with higher levels of psychiatric symptoms, even after accounting for other diabetes complications and depression treatment.
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Affiliation(s)
- Alan M Jacobson
- Research Institute, Winthrop University Hospital, Mineola, NY
| | - Barbara H Braffett
- The Biostatistics Center, The George Washington University, Rockville, MD
| | - Patricia A Cleary
- The Biostatistics Center, The George Washington University, Rockville, MD
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary E Larkin
- Diabetes Research Center, Massachusetts General Hospital, Boston, MA
| | - Hunter Wessells
- Department of Urology, University of Washington, Seattle, WA
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, MI
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