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Glucose Control Limits Erectile Dysfunction in Type 1 Diabetes

Glucose Control Limits Erectile Dysfunction in Type 1 Diabetes

By David Douglas

NEW YORK (Reuters Health) Apr 06 – Intensive glycemic therapy reduces the risk of erectile dysfunction (ED) in young men with type 1 diabetes, researchers report.

The benefit was limited to a secondary prevention cohort containing men with mild microvascular complications at baseline.

But no matter where a young man with type 1 diabetes falls on the spectrum of glucose control, "there is a benefit to tight control, namely a lower risk of ED," said lead author Dr. Hunter Wessells in email to Reuters Health. "Making young men aware of this benefit may be an additional motivator."

In a March 21st online paper in the Journal of Urology, Dr. Wessells of the University of Washington School of Medicine, Seattle, and colleagues report on nearly 600 men with type 1 diabetes who were participating in a study of intensive or conventional glycemic therapy.

A primary prevention cohort contained 366 men with diabetes for 1 to 5 years; no one had microvascular complications. The secondary prevention group contained 395 men with diabetes lasting 1 to 15 years and nonproliferative retinopathy or microalbuminuria. Patients with hypertension, ischemic heart disease, or peripheral neuropathy were excluded.

From 1983 to 1993, the men were treated for an average of 6.5 years. In 2003, researchers used a validated tool for assessment of erectile dysfunction to survey 291 men in the primary cohort and 280 members of the secondary cohort.

Overall, 23% reported erectile dysfunction. In the primary prevention cohort, there was no significant difference in ED rate between subgroups that received intensive or non-intensive therapy (20.3% vs 17.0%).

In the men with some microvascular manifestations, however, the tightly controlled patients did have a significantly lower rate of ED: 12.8%, vs 30.8% in those managed with non-intensive therapy.

Higher hemoglobin (Hb)A1c was significantly associated with ED risk in both cohorts. Other risk factors were age, peripheral neuropathy and lower urinary tract symptoms.

These findings, say the investigators, "provide further support for early implementation of intensive insulin therapy in young men with type 1 diabetes."

Dr. Wessells added, "The study also provides a basis for future work to determine whether, in men who already have ED, such improved control could reverse or improve the condition."