Do Impotent Men With Diabetes Have More Severe Erectile Dysfunction and Worse Quality of Life Than the General Population of Impotent Patients?
Results from the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) database
- David F. Penson, MD, MPH1,
- David M. Latini, PHD2,
- Deborah P. Lubeck, PHD2,
- Katrine L. Wallace, MS3,
- James M. Henning, MS3 and
- Tom F. Lue, MD2
OBJECTIVE—Little is known regarding how diabetic men with erectile dysfunction (ED) differ from the general population of impotent men. The primary objective of this study was to compare disease-specific health-related quality of life (HRQOL) and severity of ED in impotent men with and without diabetes.
RESEARCH DESIGN AND METHODS—Validated functional and HRQOL questionnaires (including the International Index of Erectile Function, the Sexual Self-Efficacy Scale, and the Psychological Impact of Erectile Dysfunction scales) were administered to patients in an ED disease registry. Men with ED and a history of diabetes (n = 20) were compared with men with ED and no history of diabetes (n = 90) at baseline and at the 12-month follow-up.
RESULTS—Diabetic impotent men reported worse erectile function and intercourse satisfaction at baseline, and ED had a greater impact on their emotional life. Diabetic men with ED had significantly different trends over time in the Erectile Function (P <>P <>P <>P <>P <>P <>
CONCLUSIONS—Impotent men with diabetes present with worse ED than nondiabetic men with ED, resulting in worse disease-specific HRQOL in the diabetic men. Although diabetic patients initially respond well to ED treatment, responses do not appear to be durable over time. Therefore, clinicians must provide longer-term follow-up when treating ED in diabetic patients.
- ED, erectile dysfunction
- ExCEED, Exploratory Comprehensive Evaluation of Erectile Dysfunction
- HRQOL, health-related quality of life
- IIEF, International Index of Erectile Function
- PIED, Psychological Impact of Erectile Dysfunction
- VA, Veterans Administration
Erectile dysfunction (ED) is a common complication of diabetes, with prevalence ranging between 27 and 75% (1–3). Despite the high prevalence of this condition in patients with diabetes, little is known regarding how diabetic subjects with ED differ from the general population of impotent men. Comparison of randomized clinical trials assessing the efficacy of sildenafil show that diabetic men with ED differ from the general population of impotent men in their response to oral therapy (4,5). However, it is not known whether diabetic men present with worse sexual dysfunction than impotent patients from the general population or whether ED has a different impact on quality of life in diabetic men when compared with nondiabetic patients.
In fact, little is known regarding the impact ED has on quality of life in diabetic subjects. To date, there has been a single study that specifically examined health-related quality of life (HRQOL) in impotent men with diabetes. De Berardis et al. (6) used the Short Form 36 (SF-36) to study general HRQOL in 1,460 men with diabetes. Of these patients, 34% reported frequent erectile problems. Impotent diabetic subjects were more likely to report depressive symptoms, have lower scores in the mental domains of the SF-36, and report a less satisfactory sex life. Although this cross-sectional study demonstrates that ED has a deleterious effect on quality of life in diabetic men, it does not address how ED treatment affects HRQOL in diabetic subjects. Furthermore, it does not assess whether the impact of ED on quality of life differs in diabetic subjects when compared with the general population of impotent men.
The primary objective of the current study was to compare disease-specific HRQOL and severity of ED in impotent men with and without a history of diabetes. In addition, the longitudinal effect of ED treatment on sexual function and HRQOL was compared in the two groups. To accomplish these goals, data from the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED) database, a multicenter longitudinal observational disease registry of men with ED, were used. Importantly, HRQOL was measured using the Psychological Impact of Erectile Dysfunction (PIED) scale, one of the few ED-specific HRQOL instruments that has been appropriately tested and found to be psychometrically valid and reliable (7).