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Global prevalence of erectile dysfunction and its associated risk factors among men with type 1 diabetes: a systematic review and meta-analysis

International Journal of Impotence Research (2024)Cite this article

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Abstract

Various observational studies have examined the prevalence and determinants of erectile dysfunction (ED) in men with type 1 diabetes across different geographical areas. Nevertheless, a comprehensive systematic review and meta-analysis to consolidate the worldwide prevalence and risk factors remains lacking. Hence, the primary study objective was to perform an extensive systematic review and meta-analysis that specifically examined ED prevalence and determinants in men with type 1 diabetes. A thorough exploration was conducted by examining electronic databases, such as PubMed, Embase, and Web of Science. The general ED prevalence and a 95% confidence interval (CI) in men with type 1 diabetes were summarized. The relevant risk factors were analyzed by deriving a comprehensive odds ratio (OR) from merging the ORs using fixed- or random-effects models. The sources of heterogeneity were investigated using subgroup analyses and meta-regression. This systematic review and meta-analysis included 19 articles involving 3788 men with type 1 diabetes. The meta-analysis revealed that men with type 1 diabetes had a combined ED prevalence of 42.5% (95% CI: 34.3%–50.8%). This prevalence showed significant heterogeneity (I2 = 96.2%, P < 0.01). Meta-regression revealed that age (P = 0.016) and type 1 diabetes duration (P = 0.004) were significant causes of heterogeneity. Furthermore, the ED risk in men with type 1 diabetes was significantly influenced by age, type 1 diabetes duration, body mass index, glycated hemoglobin (HbA1c), retinopathy, and smoking habits (all P < 0.05). In summary, this systematic review and meta-analysis revealed a significant prevalence of ED in men with type 1 diabetes, highlighting the importance of clinicians addressing concerns regarding ED in this specific group of individuals.

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Fig. 1
Fig. 2: Forest plot of ED prevalence among men with type 1 diabetes.
Fig. 3
Fig. 4
Fig. 5: Forest plot of the OR of ED among men with type 1 diabetes compared to controls.
Fig. 6: Forest plot of the ED risk factors among men with type 1 diabetes.

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The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding author.

References

  1. Lovic D, Piperidou A, Zografou I, Grassos H, Pittaras A, Manolis A. The growing epidemic of diabetes mellitus. Curr Vasc Pharm. 2020;18:104–9.

    Article  CAS  Google Scholar 

  2. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383:69–82.

    Article  PubMed  Google Scholar 

  3. Melendez-Ramirez LY, Richards RJ, Cefalu WT. Complications of type 1 diabetes. Endocrinol Metab Clin North Am. 2010;39:625–40.

    Article  PubMed  Google Scholar 

  4. Xu G, Liu B, Sun Y, Du Y, Snetselaar LG, Hu FB, et al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ. 2018;362:k1497.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nat Rev Dis Prim. 2016;2:16003.

    Article  PubMed  Google Scholar 

  6. MacDonald SM, Burnett AL. Physiology of erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2021;48:513–25.

    Article  PubMed  Google Scholar 

  7. Chitaley K, Kupelian V, Subak L, Wessells H. Diabetes, obesity and erectile dysfunction: field overview and research priorities. J Urol. 2009;182:S45–50.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kouidrat Y, Pizzol D, Cosco T, Thompson T, Carnaghi M, Bertoldo A, et al. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med. 2017;34:1185–92.

    Article  CAS  PubMed  Google Scholar 

  9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Brunner GA, Pieber TR, Schattenberg S, Ressi G, Wieselmann G, Altziebler S, et al. [Erectile dysfunction in patients with type I diabetes mellitus]. Wien Med Wochenschr. 1995;145:584–6.

    CAS  PubMed  Google Scholar 

  11. Azmi S, Ferdousi M, Alam U, Petropoulos IN, Ponirakis G, Marshall A, et al. Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study. Diabetologia. 2017;60:1094–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care. 2002;25:1458–63.

    Article  PubMed  Google Scholar 

  13. Caruso P, Cirillo P, Carbone C, Sarnataro A, Maiorino MI, Bellastella G, et al. Sexual dysfunctions and short-term glucose variability in young men with type 1 diabetes. Hormones. 2021;20:475–82.

    Article  PubMed  Google Scholar 

  14. Hylmarova S, Stechova K, Pavlinkova G, Peknicova J, Macek M, Kvapil M. The impact of type 1 diabetes mellitus on male sexual functions and sex hormone levels. Endocr J. 2020;67:59–71.

    Article  PubMed  Google Scholar 

  15. Dan A, Chakraborty K, Mondal M, Neogi R, Chatterjee S, Makhal M. Erectile dysfunction in patients with diabetes mellitus: its magnitude, predictors and their bio-psycho-social interaction: a study from a developing country. Asian J Psychiatr. 2014;7:58–65.

    Article  PubMed  Google Scholar 

  16. 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. On behalf of Gruppo Italiano Studio Deficit Erettile nei Diabetici. Int J Epidemiol. 2000;29:524–31.

    Article  CAS  PubMed  Google Scholar 

  17. Kulecki M, Naskret D, Kaminski M, Kasprzak D, Lachowski P, Klause D, et al. Arterial stiffness and the non-dipping pattern in type 1 diabetes males with and without erectile dysfunction. Sci Rep. 2023;13:7265.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kaminski M, Kulecki M, Lachowski P, Kasprzak D, Kulczycka A, Kozlowska M, et al. Erectile dysfunction in individuals with Type 1 diabetes is associated with long-term metabolic control and diabetic complications: a cross-sectional study. Int J Angiol. 2022;31:97–106.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Nisahan B, Kumanan T, Rajeshkannan N, Peranantharajah T, Aravinthan M. Erectile dysfunction and associated factors among men with diabetes mellitus from a tertiary diabetic center in Northern Sri Lanka. BMC Res Notes. 2019;12:210.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Maiorino MI, Bellastella G, Della Volpe E, Casciano O, Scappaticcio L, Cirillo P, et al. Erectile dysfunction in young men with type 1 diabetes. Int J Impot Res. 2017;29:17–22.

    Article  CAS  PubMed  Google Scholar 

  21. Kalter-Leibovici O, Wainstein J, Ziv A, Harman-Bohem I, Murad H, Raz I, et al. Clinical, socioeconomic, and lifestyle parameters associated with erectile dysfunction among diabetic men. Diabetes Care. 2005;28:1739–44.

    Article  PubMed  Google Scholar 

  22. Klein R, Klein BE, Moss SE. Ten-year incidence of self-reported erectile dysfunction in people with long-term type 1 diabetes. J Diabetes Complicat. 2005;19:35–41.

    Article  Google Scholar 

  23. Pop-Busui R, Braffett BH, Wessells H, Herman WH, Martin CL, Jacobson AM, et al. Diabetic peripheral neuropathy and urological complications in Type 1 diabetes: findings from the epidemiology of diabetes interventions and complications study. Diabetes Care. 2022;45:119–26.

    Article  CAS  PubMed  Google Scholar 

  24. Van Cauwenberghe J, Enzlin P, Nefs G, Ruige J, Hendrieckx C, De Block C, et al. Prevalence of and risk factors for sexual dysfunctions in adults with type 1 or type 2 diabetes: results from Diabetes MILES - Flanders. Diabet Med. 2022;39:e14676.

    Article  PubMed  Google Scholar 

  25. Wang F, Dai S, Wang M, Morrison H. Erectile dysfunction and fruit/vegetable consumption among diabetic Canadian men. Urology. 2013;82:1330–5.

    Article  PubMed  Google Scholar 

  26. Turek SJ, Hastings SM, Sun JK, King GL, Keenan HA. Sexual dysfunction as a marker of cardiovascular disease in males with 50 or more years of type 1 diabetes. Diabetes Care. 2013;36:3222–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Georgescu O, Reghina A, Ioacara S, Fica S. Androgen deficiency, erectile dysfunction and chronic microvascular complications in male diabetic patients. Rom J Diabetes Nutr Metab Dis. 2013;20:401–7.

    CAS  Google Scholar 

  28. Jamieson F, Chalmers J, Duncan C, Prescott RJ, Campbell IW. Erectile dysfunction in type 1 diabetic males. Br J Diabetes Vasc Dis. 2008;8:232–4.

    Article  Google Scholar 

  29. Manalo TA, Biermann HD, Patil DH, Mehta A. The temporal association of depression and anxiety in young men with erectile dysfunction. J Sex Med. 2022;19:201–6.

    Article  PubMed  Google Scholar 

  30. Li H, Gao T, Wang R. The role of the sexual partner in managing erectile dysfunction. Nat Rev Urol. 2016;13:168–77.

    Article  CAS  PubMed  Google Scholar 

  31. Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84:50–56.

    Article  CAS  PubMed  Google Scholar 

  32. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile dysfunction in young men-a review of the prevalence and risk factors. Sex Med Rev. 2017;5:508–20.

    Article  PubMed  Google Scholar 

  33. Hunter CS, Stein RW. Evidence for loss in identity, de-differentiation, and trans-differentiation of Islet beta-Cells in Type 2 diabetes. Front Genet. 2017;8:35.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    Article  CAS  PubMed  Google Scholar 

  35. Maiorino MI, Bellastella G, Petrizzo M, Della Volpe E, Orlando R, Giugliano D, et al. Circulating endothelial progenitor cells in type 1 diabetic patients with erectile dysfunction. Endocrine. 2015;49:415–21.

    Article  CAS  PubMed  Google Scholar 

  36. Pajovic B, Dimitrovski A, Fatic N, Malidzan M, Vukovic M. Vacuum erection device in treatment of organic erectile dysfunction and penile vascular differences between patients with DM type I and DM type II. Aging Male. 2017;20:49–53.

    Article  PubMed  Google Scholar 

  37. Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381:153–65.

    Article  CAS  PubMed  Google Scholar 

  38. Toschi E. Type 1 diabetes and aging. Endocrinol Metab Clin North Am. 2023;52:389–403.

    Article  PubMed  Google Scholar 

  39. Wessells H, Penson DF, Cleary P, Rutledge BN, Lachin JM, McVary KT, et al. Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes. J Urol. 2011;185:1828–34.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bortolotti A, Fedele D, Chatenoud L, Colli E, Coscelli C, Landoni M, et al. Cigarette smoking: a risk factor for erectile dysfunction in diabetics. Eur Urol. 2001;40:392–6.

    Article  CAS  PubMed  Google Scholar 

  41. Liu Q, Zhang Y, Wang J, Li S, Cheng Y, Guo J, et al. Erectile dysfunction and depression: a systematic review and meta-analysis. J Sex Med. 2018;15:1073–82.

    Article  PubMed  Google Scholar 

  42. Farooqi A, Gillies C, Sathanapally H, Abner S, Seidu S, Davies MJ, et al. A systematic review and meta-analysis to compare the prevalence of depression between people with and without Type 1 and Type 2 diabetes. Prim Care Diabetes. 2022;16:1–10.

    Article  PubMed  Google Scholar 

  43. Buchberger B, Huppertz H, Krabbe L, Lux B, Mattivi JT, Siafarikas A. Symptoms of depression and anxiety in youth with type 1 diabetes: a systematic review and meta-analysis. Psychoneuroendocrinology. 2016;70:70–84.

    Article  PubMed  Google Scholar 

  44. Ma K, Song P, Liu Z, Yang L, Wang L, Zhou J, et al. Genetic evidence suggests that depression increases the risk of erectile dysfunction: a Mendelian randomization study. Front Genet. 2022;13:1026227.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Rawshani A, Sattar N, Franzen S, Rawshani A, Hattersley AT, Svensson AM, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392:477–86.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hietala K, Harjutsalo V, Forsblom C, Summanen P, Groop PH, FinnDiane Study G. Age at onset and the risk of proliferative retinopathy in type 1 diabetes. Diabetes Care. 2010;33:1315–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

The research was funded by the Shaoxing Health Science and Technology Project (Grant Number 2022KY012).

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  1. Department of Urology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China

    Xiaolong Zhang, Zhirong Zhu & Guiliang Tang

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XLZ provided the presented idea. XLZ, ZRZ, and GLT performed the data analysis. XLZ wrote the manuscript. GLT did critical reading and editing the manuscript. All authors discussed the results and contributed to the final manuscript.

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Correspondence to Guiliang Tang.

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Zhang, X., Zhu, Z. & Tang, G. Global prevalence of erectile dysfunction and its associated risk factors among men with type 1 diabetes: a systematic review and meta-analysis. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00855-0

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