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Association between comorbidity and erectile dysfunction in patients with diabetes

International Journal of Impotence Research volume 18, pages 348–353 (2006)Cite this article

Abstract

The aims of this study were to determine the prevalence of erectile dysfunction (ED) and its relationship with comorbidity in patients with diabetes. The study population comprised of 312 consecutive patients aged 20 years or over residing in the city of Hamadan in Iran in 2005. Depression was assessed by the modified version of the Beck Depression Inventory (BDI-II) and ED by the short form of the International Index of Erectile Function (IIEF-5) questionnaire. Potential confounding was controlled by stratification and by a logistic regression model. The prevalence of moderate or complete ED (IIEF score ⩽11) was 34% and that of moderate or severe depressive symptoms 30%. Each 1-year increment in diabetes duration was associated with a 10% higher risk of ED. The risk of ED was higher in men with depression (odds ratio (OR)=10.7, 95% CI 5.4–21.1) and in those with cardiovascular disease (CVD) (OR=2.0, 95% CI 1.1–3.6). CVD was associated with ED only in elderly men, whereas depression was related to ED in both young and older subjects. The risk of ED was higher in subjects with both depression and CVD (OR=17.2, 95% CI 6.8–43.1 compared with men free from both diseases). Subjects who consumed fruits weekly or seldom had a higher risk of ED (OR=3.2) compared with those who consumed daily. Our study shows a strong association between depressive symptoms and ED. The association is much stronger for older men. Depression and CVD may interact with one another in relation to a higher risk of ED. A diet rich in fruits may have a beneficial effect on erectile function.

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References

  1. Fedele D, Bortolotti A, Coscelli C, Santeusanio F, Chatenoud L, Colli E et al. Erectile dysfunction in type 1 and type 2 diabetics in Italy. Int J Epidemiol 2000; 29: 524–531.

    Article  CAS  Google Scholar 

  2. Klein R, Klein BE, Lee KE, Moss SE, Cruickshanks KJ . Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996; 19: 135–141.

    Article  CAS  Google Scholar 

  3. Shiri R, Koskimaki J, Hakama M, Hakkinen J, Tammela TL, Huhtala H et al. Effect of chronic diseases on the incidence of erectile dysfunction. Urology 2003; 62: 1097–1102.

    Article  Google Scholar 

  4. MacDonagh R, Ewings P, Porter T . The effect of erectile dysfunction on quality of life: psychometric testing of a new quality of life measure for patients with erectile dysfunction. J Urol 2002; 167: 212–217.

    Article  Google Scholar 

  5. Anderson RJ, Freedland KF, Clouse RE, Lustman PJ . The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24: 1069–1078.

    Article  CAS  Google Scholar 

  6. Golden SH, Williams JE, Ford DE, Yeh HC, Paton Sanford C, Nieto FJ et al. Depressive symptoms and the risk of type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 2004; 27: 429–435.

    Article  Google Scholar 

  7. Brown LC, Majumdar SR, Newman SC, Johnson JA . History of depression increases risk of type 2 diabetes in younger adults. Diabetes Care 2005; 28: 1063–1067.

    Article  Google Scholar 

  8. Bonnet F, Irving K, Terra JL, Nony P, Berthezene F, Moulin P . Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis 2005; 178: 339–344.

    Article  CAS  Google Scholar 

  9. Moore TM, Strauss JL, Herman S, Donatucci CF . Erectile dysfunction in early, middle, and late adulthood: symptom patterns and psychosocial correlates. J Sex Marital Ther 2003; 29: 381–399.

    Article  Google Scholar 

  10. Nicolosi A, Moreira Jr ED, Villa M, Glasser DB . A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men. J Affect Disord 2004; 82: 235–243.

    Article  Google Scholar 

  11. Althof SE, Cappelleri JC, Shpilsky A, Stecher V, Diuguid C, Sweeney M et al. Treatment responsiveness of the Self-Esteem And Relationship (SEAR) questionnaire in erectile dysfunction. Urology 2003; 61: 888–893.

    Article  Google Scholar 

  12. Althof SE . Quality of life and erectile dysfunction. Urology 2002; 59: 803–810.

    Article  Google Scholar 

  13. Seidman SN, Roose SP, Menza MA, Shabsigh R, Rosen RC . Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001; 158: 1623–1630.

    Article  CAS  Google Scholar 

  14. Roose SP . Depression: links with ischemic heart disease and erectile dysfunction. J Clin Psychiatry 2003; 64 (Suppl 10): 26–30.

    PubMed  Google Scholar 

  15. Haas DC, Davidson KW, Schwartz DJ, Rieckmann N, Roman MJ, Pickering TG et al. Depressive symptoms are independently predictive of carotid atherosclerosis. Am J Cardiol 2005; 95: 547–550.

    Article  Google Scholar 

  16. Rugulies R . Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med 2002; 23: 51–61.

    Article  Google Scholar 

  17. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421–431.

    Article  CAS  Google Scholar 

  18. Beck AT, Brown G, Steer RA . Beck Depression Inventory II Manual. The Psychological Corporation: San Antonio, TX, 1996.

    Google Scholar 

  19. Lasa L, Ayuso-Mateos JL, Vazquez-Barquero JL, Diez-Manrique FJ, Dowrick CF . The use of the Beck Depression Inventory to screen for depression in the general population: a preliminary analysis. J Affect Disord 2000; 57: 261–265.

    Article  CAS  Google Scholar 

  20. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM . Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319–326.

    Article  CAS  Google Scholar 

  21. Cappelleri JC, Siegel RL, Glasser DB, Osterloh IH, Rosen RC . Relationship between patient self-assessment of erectile function and the Sexual Health Inventory for Men. Clin Ther 2001; 23: 1707–1719.

    Article  CAS  Google Scholar 

  22. Cappelleri JC, Rosen RC . The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res 2005; 17: 307–319.

    Article  CAS  Google Scholar 

  23. El-Sakka AI, Tayeb KA . Erectile dysfunction risk factors in non-insulin dependent diabetic Saudi patients. J Urol 2003; 169: 1043–1047.

    Article  Google Scholar 

  24. Yamasaki H, Ogawa K, Sasaki H, Nakao T, Wakasaki H, Matsumoto E et al. Prevalence and risk factors of erectile dysfunction in Japanese men with type 2 diabetes. Diabetes Res Clin Pract 2004; 66 (Suppl 1): S173–S177.

    Article  Google Scholar 

  25. Siu SC, Lo SK, Wong KW, Ip KM, Wong YS . Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients. Diabet Med 2001; 18: 732–738.

    Article  CAS  Google Scholar 

  26. Sullivan ME, Keoghane SR, Miller MA . Vascular risk factors and erectile dysfunction. BJU Int 2001; 87: 838–845.

    Article  CAS  Google Scholar 

  27. Lehto S, Ronnemaa T, Pyorala K, Laakso M . Poor glycemic control predicts coronary heart disease events in patients with type 1 diabetes without nephropathy. Arterioscler Thromb Vasc Biol 1999; 19: 1014–1019.

    Article  CAS  Google Scholar 

  28. Gazzaruso C, Giordanetti S, De Amici E, Bertone G, Falcone C, Geroldi D et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation 2004; 110: 22–26.

    Article  Google Scholar 

  29. De Angelis L, Marfella MA, Siniscalchi M, Marino L, Nappo F, Giugliano F et al. Erectile and endothelial dysfunction in type II diabetes: a possible link. Diabetologia 2001; 44: 1155–1160.

    Article  CAS  Google Scholar 

  30. Safarinejad MR . Oral sildenafil in the treatment of erectile dysfunction in diabetic men: a randomized double-blind and placebo-controlled study. J Diabetes Complications 2004; 18: 205–210.

    Article  Google Scholar 

  31. Rendell MS, Rajfer J, Wicker PA, Smith MD . Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA 1999; 281: 421–426.

    Article  CAS  Google Scholar 

  32. Lepore G, Nosari I . Efficacy of oral sildenafil in the treatment of erectile dysfunction in diabetic men with positive response to intracavernosal injection of alprostadil. Diabetes Care 2001; 24: 409–411.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Tampere School of Public Health, University of Tampere, Tampere, Finland

    R Shiri & K Falah Hassani

  2. Department of Internal Medicine, Mobasher Hospital, Hamadan University of Medical Sciences, Hamadan, Iran

    M Ansari

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Correspondence to R Shiri.

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Shiri, R., Ansari, M. & Falah Hassani, K. Association between comorbidity and erectile dysfunction in patients with diabetes. Int J Impot Res 18, 348–353 (2006). https://doi.org/10.1038/sj.ijir.3901432

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