European Journal of Cardiovascular Medicine

The prevalence of Diabetes Mellitus is increasing worldwide. It is the most common chronic metabolic abnormally, leading cause of death now (1,2,3). The complications of Diabetes Mellitus are due to microvascular and macrovascular involvement (4,5 ). Diabetes Mellitus is also associated with sexual dysfunction in both men and women (6,7). The sexual dysfunction in men presents with Erectile dysfunction (ED) (8,9). ED in men is defined as inability to attain and maintain erection of penis during sexual Intercourse (10,11). The prevalence of ED among non diabetic males ranges between 5% at 30 years to 50% at 75 years. The prevalence is higher among diabetic males (12,13).

Aim of the study:

1. To estimate the prevalence of ED among diabetic males.
2. To analyse the factors associated with ED in diabetic males.

Inclusion criteria:

Diabetic males of age group between 25 years to 65 years.

Exclusion criteria:

1. Type 1 Diabetic males.
2. Type 2 diabetic males with complications like CAD, Stroke, CKD stage III or more and diabetic neuropathy. 
   Diabetic patients with other degenerative neuropathies.
   HIV positive diabetic males.

360 diabetic males who attended the Diabetic clinic of a tertiary care hospital during the period between April 2022 and March 2023 were included in the study.  After obtaining informed consent form the patients, History of duration of Diabetes was obtained form the patient.  Their height and weight were checked to calculate the Body mass index. The Erectile function of the patients was assessed using the International Index For Erectile Function- 5 ( IIEF -5 ) questionnaire.  The IIEF questionnaire has 5 items with a score of 0 to 5 for each item. The maximum total score is 25 and the minimum total score is O. A score of 22 or more is considered as  ED negative and a score of less than 22 is considered as ED positive. The ED positive group of patients are further classified into mild, mild to moderate , moderate and severe ED based on their IIEF - 5 score as shown in table 1.

Table 1: International Index for erectile function – 5 score

5 ml of venous blood was collected from each patients and tested for HbA1c , Lipid profile, uric acid,  HsCRP and Testosterone (total) levels. The correlation between these parameters and the IIEF -5 score was also calculated using Pearson's coefficient ( Table 2 )

Table 2: Correlation of IIEF -5 scores with different suspected variables.

The patients were divided into 2 groups , those with IIEF -5 score of 22 or more as "ED negative" group and those with IIEF -5 score of less than 22 as "ED positive" group.

The mean values of Age , BMI , Duration of DM ,HbA1c,  LDL cholesterol,  HDL cholesterol,  Triglycerides, Uric acid,  HsCRP and

Testosterone(total) of these two groups were compared for statistical significance using unpaired T test. A p value of < 0.05 is considered as stistically significant (Table 3 )

Table 3: Factors associated with ED in diabetic males.

The prevalence of ED among male diabetic patients in our study is 45% (162/360 ). These patients with ED were further classified into mild ED , mild to moderate ED , moderate ED and severe ED based on their IIEF-5 scores ( Table 4 )

Table 4: Prevalence of ED among diabetic males

The prevalence of ED in various other studies ranges from 35 - 90 % (14,15) . Studies from united states , Netherlands and Saudi Arabia have reported the prevalence of ED as 50% , 41 %  and 90 % respectively (16 - 19 ) .In our study the IIEF-5 score showed a strong correlation with Age and BMI , moderate correlation with duration of Diabetes, uric acid levels and HsCRP levels weak correlation with HbA1c levels,  HDL cholesterol,  LDL cholesterol and Testosterone (total) levels. ( Table 2 ) .

The mean age of ED positive group patients was significantly higher than those of the ED negative group patients.  Similar correlation was also reported in the study by Sharifi et al (20) . The BMI of the diabetic males with ED positive was significantly more than those with ED negative in our study. Study by Shi et al (21) and others ( 22,23 ) also showed Similar correlation. The duration of Diabetes was also significantly higher in the ED positive group whereas HbA1c levels did not show any significant difference between the two groups.  In the lipid profile Triglycerides level were significantly higher and the HDL cholesterol levels were significantly lower in the ED positive group when compared with the ED negative group whereas the LDL cholesterol levels did not show any significant difference.  The mean HsCRP levels in the ED positive group was significantly higher than the ED negative group.  Study by Blans et al (24) , yo et al (25) and Vlachopous et al (26 ) also showed a Similar correlation.  The serum uric acid levels also showed a significant difference between the two groups.  There are various proposed mechanisms by which uric acid is linked with endothelial dysfunction, microvascular complications ,macrovascular complications and erectile dysfunction.  ( 27 - 36 ) . The serum Testosterone ( total) levels did not show any significant difference between the two groups.

The prevalence of erectile dysfunction among diabetic males is high and is associated with increasing age of the patients, duration of diabetics, high BMI, low HDL , high Triglycerides,  high HsCRP and high uric acid levels. 

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