February 06, 2014
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Aggressive erectile dysfunction therapy more likely in men with diabetes

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In a study of men with erectile dysfunction, those with diabetes were 1.5-fold to twofold more likely to pursue aggressive treatments.

“Although the exact pathogenesis of diabetes-associated [erectile dysfunction] is not completely understood, other diabetic complications associated with [erectile dysfunction] include hypertension, peripheral neuropathy, nephropathy and retinopathy, suggesting roles for both neurologic and vascular impairment,” researchers wrote.

These findings indicate that erectile dysfunction among men with diabetes could be less responsive to first-line treatments such as oral PDE-5 inhibitors, according to Thomas J. Walsh, MD, of the department of urology at the University of Washington School of Medicine, and colleagues.

Diabetes had preceded 19,236 (14%) patients’ diagnosis of prevalent and incident erectile dysfunction in the 136,306 men included in the claims-based study conducted from 2002 to 2006.

The rate of erectile dysfunction tended to increase with age and was most prevalent among non-white men aged 60 to 64 years, according to data.

Of the 19,236 with diabetes, 538 (2.8%) were treated with second-line therapies, and 2,134 (1.8%) of the 117,070 men without diabetes were treated with second-line therapies.

Therefore, patients with diabetes were 60% more likely to be prescribed secondary therapies for erectile dysfunction within 5 years of diagnosis compared with men without diabetes (OR=1.6; 95% CI, 1.4-1.7). Similarly, 50% were more likely to be prescribed secondary therapies for erectile dysfunction during the 2-year observational period, according to researchers.

Additional data indicated that 125 men with diabetes (0.8%) underwent third-line therapy compared with 437 men without diabetes (0.4%). Men with diabetes were twice as likely to undergo penile prosthesis surgery (OR=2.1; 95% CI, 1.8-2.6) compared with men without diabetes.

“Among all men with [erectile dysfunction], progression to second- and third-line therapies was most dramatic within the first 6 months of [erectile dysfunction] diagnosis,” researchers wrote.

Men with diabetes demonstrated a significant progression toward second- and third-line therapies vs. men without diabetes (P<.001), according to data.

Claims-based data such as these demonstrate a need for earlier and possibly more aggressive interventions in men with diabetes, researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.