In:
The Journal of Sexual Medicine, Oxford University Press (OUP), Vol. 14, No. 10 ( 2017-10-01), p. 1187-1194
Abstract:
Men with diabetes are at greater risk of erectile dysfunction (ED). Aim To describe the natural history of ED in men with type 1 diabetes. Methods We examined up to 30 years of prospectively collected annual ED status and demographic and clinical variables from 600 male participants in the Diabetes Control and Complications Trial (DCCT; 1983–1993) and its follow-up study, the Epidemiology of Diabetes Interventions and Complications (1994–present; data in this study are through 2012). Outcomes Yes vs no response to whether the participant had experienced impotence in the past year and whether he had used ED medication. Results Sixty-one percent of men reported ED at least once during the study. For some men, the initial report of ED was permanent. For others, potency returned and was lost multiple times. Visual display of the data showed four longitudinal ED phenotypes: never (38.7%), isolated (6.7%), intermittent (41.8%), and persistent (12.8%). Men who never reported ED or in only 1 isolated year were younger, had lower body mass index, and better glycemic control than men in the intermittent and persistent groups at DCCT baseline. In a multivariable logistic model comparing men at their first year reporting ED, men who were older had lower odds of remission and men who were in the conventional DCCT treatment group had higher odds of remission. Clinical Translation If validated in other cohorts, such findings could be used to guide individualized interventions for patients with ED. Strengths and Limitations This is the first examination of ED with repeated measures at an annual resolution, with up to 30 years of responses for each participant. However, the yes vs no response is a limitation because the real phenotype is not binary and the question can be interpreted differently depending on the participant. Conclusions Age, glycemic control, and BMI were important longitudinal predictors of ED. We have described a more complex ED phenotype, with variation in remission patterns, which could offer insight into different mechanisms or opportunities for intervention. If validated in other cohorts, such findings could be used to establish more accurate prognostication of outcomes for patients with ED to guide individualized interventions.
Type of Medium:
Online Resource
ISSN:
1743-6109
,
1743-6095
DOI:
10.1016/j.jsxm.2017.07.012
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2017
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