Diabetes and vascular impotence: does insulin dependence increase the relative severity?

Abstract

Aim of the study: Diabetes is a well documented risk factor for vascular erectile dysfunction (ED). We evaluated the relative roles of insulin dependence (IDDM) vs oral agent controlled diabetes (NIDDM) in predicting the etiologies and severity of ED: arterial insuf®ciency (AI), venous leakage (CVOD), and mixed vascular disease. The impact of additional risk factors were also analyzed: hypertension (HTN), coronary artery disease (CAD), and smoking (SM). Methods: Retrospective data on 105 patients complaining of impotence who underwent pharmacotesting with PGE1 (Caverject) and color duplex Doppler was reviewed. Penile blood ow study (PBFS) data following a period of privacy and self-stimulation was compared. PBFS diagnostic criteria were: AI for peak systolic velocity (PSV)<25 cmas; CVOD for PSV!35 cmas and resistive index (RI)<0.9; mixed vascular disease for PSV!25 cmas, PSV<35 cmas and RI>0.9. Consistent dosing of PGE1 was used; 6 mcg for age<60 y and 10 mcg for age !60 y. Patients were NIDDM (79 out of 105) and IDDM (26 out of 105). Mean ages for NIDDM and IDDM were respectively 60, and 55 y. The relative signi®cance of insulin dependence was assessed by Student's t-test. Results: The most common etiology of ED was arterial insuf®ciency: mean PSV's did not signi®cantly vary and were: 23.5 cmas for NIDDM, and 21.6 cmas for IDDM. PBFS parameters did not vary signi®cantly for the risk factors of SM or HTN and diabetes. Mean peak systolic velocities were signi®cantly different among diabetics with coronary artery disease: NIDDMaCAD, 22.9 cmas compared to IDDMaCAD, 14.8 cmas (P 0.006). Conclusions: We found among the 105 diabetics the most common etiology of vascular ED based on Doppler criteria was arterial insuf®ciency, 64%. Statistical analysis of additional risk factors (SM, HTN, CAD) suggested that patients with IDDM and CAD have more severe cavernosal arterial insuf®ciency than patients with NIDDM and CAD. This data tends to support the theory that microangiopathy is the predominant factor in diabetic impotence, and that insulin dependent diabetes with`large vessel' coronary heart disease have a similar pathology in the`small vessels' regulating penile in¯ow which is unfortunately worse than their non-insulin dependent counterparts.

Erectile and endothelial dysfunction in Type II diabetes: a possible link

“…A link between the pathogenesis of ED and decreased local nitric oxide activity has been suggested because in isolated corpus cavernosum strips from diabetic patients with ED both neurogenic and endothelium-dependent relaxation were impaired [5]. In our study, diabetic patients with ED presented evidence of abnormal endothelial functions.…”

“…pharmacological factors [2]. There is a greater incidence of peripheral neuropathy [3], microangiopathy [4] and arterial insufficiency [5] in diabetic patients with ED than in potent diabetic men. Furthermore, diabetic patients could have other co-morbid conditions that are associated with ED without diabetes, such as renal failure, hypertension and chronic liver disease, thus the precise association of diabetes with ED could be circumstantial.…”

Relation of C-reactive protein and other cardiovascular risk factors to penile vascular disease in men with erectile dysfunction

“…Determination of severity classification based on Doppler values was derived from previously published criteria. 9,10 Questionnaires Subjects completed a cardiac risk questionnaire based on items chosen from the Framingham criteria to calculate coronary artery disease (CAD) risk score. 11 In addition, the five-item abbreviated version of the International Index of Erectile Function (IIEF-5) was used to assess erectile function.…”

Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: A community survey among 1,412 Israeli men

“…Sexually active diabetic men have a significantly lower cavernosal artery peak blood flow velocity and diameter increase rate than nondiabetics 19 2. Arterial insufficiency due to local microangiopathy 20 3. Failure of the veins to close during an erection (venoocclusive dysfunction) as a result of degenerative changes of the tunica albuginea reported in diabetics 8 can cause ED 21 4.…”