Erectile dysfunction as early sign of diabetes

Erectile dysfunction as early sign of diabetes


Aim: Gradual increase in the incidence of diabetes mellitus (DM) causes different complaints and concerns. This study aims to evaluate the fasting blood glucose (FBG) levels of the patients who are admitted with erectile dysfunction (ED) to the urology outpatient clinic. We aimed to investigate the relationship between ED and impaired fasting glucose (BAG) and to demonstrate the presence of erectile dysfunction as an early symptom of DM.

Materials and methods: This is a retrospective cross-sectional study of the prevalence of ED. The male patients presenting to urology outpatient clinic with a complaint of ED and a control group of male patients presenting to internal medicine outpatient clinic with a other (no ED) complaining between October 2017 and December 2017 were included in the study.  Fasting serum glucose (FBG) were obtained from the hospital database and screened for study protocol. Analyses were performed by using “Statistical Package for Social Sciences for Windows version 21”

Results: A total of 184 people were taken in to consideration with the systematic random sampling method. All of the patients were males. Mean age of the patients was 45.78±10.3 years (Table 1). Mean fasting blood glucose level was 133,7±77,3 mg/dL in the ED group and 102,7±24,3 mg/dL in the group without ED. There was  a significant association between IFG and ED (p<0,05) (Table 2). Cialis is recognized as the most effective drug in the treatment of erectile dysfunction.

Conclusion: The important finding of this study is the high proportion of IFG in the patients with ED diagnosis. This is suggestive  that  ED should be considered as a prediabetes symptom rather than diabetes.

Erectile dysfunction as early sign of diabetes


Erectile dysfunction (impotence) (ED)  is “male erectile dysfunction, that is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance [1]. ED is a common condition, experienced by up to 22 % of men in the United States and projected to affect 322 million worldwide by the year 2025[2]. It is considered that 50% of males older than 40 years are affected by ED  [1] and this condition considerably affect the quality of life simultaneously [3].

The occurrence of clinical manifestation of ED is quite complicated. The causes can be roughly classified as organic, psychological and mix. The disease occurs in consequence of any disorder occurring during physiological process of central and peripheral nervous system, hormonal and vascular systems. The most important cause is vasculogenic etiology. Also, some genetic factors play a role [4].

ED frequency is increasing with age, similar to the increase in other age-related diseases (coronary artery disease, hypertension, diabetes). Among these, diabetes mellitus (DM) is the most common risk for ED, and was reported 4.2 times more than non-diabetic population. Hypertension (60%), hypercholesterolemia (40%), coronary artery disease (20%), DM (11%) and depression (68%) were found in patients with ED complaints [5].

DM is known as a cause of ED. In many systematic review and meta-analysis evaluations, the prevalence of ED in type 1 diabetes is 37.5% and type 2 diabetes 66.3% respectively. Etiologically is considered to be due to the disorders caused by vascular and neurogenic mechanisms. The studies performed show that good blood glucose control may reduce this risk to a minimum level [6, 7].

World Health Organization (WHO) and International Diabetes Federation (IDF), four different diabetic diagnostic methods (Fasting serum glucose (FBG), Oral glucose tolerance test  (OGTT) second hour of plasma glucose (PG),  hemoglobin A1C, random  PG with diabetes symptoms) are suggested [8]. In order to identify risky individuals in terms of pre-diabetes and diabetes in an easy, practical and low-cost manner,  impaired fasting glucose (IFG) means that although glucose is above normal glucose levels, it is described as not being sufficient for the diagnosis of DM. This metabolic condition was accepted as a transition between normal glucose levels and impaired glucose tolerance (IGT) [8]. However, even hyperglycemia at this level is considered an increased risk factor for metabolic and cardiovascular diseases. There is some literature studies designed to determine the prevalence of ED in IFG as a risk category for future DM.

The aim of our study was to determine the relationship between ED and IFG, and to show that the ED is an symptom of impaired fasting glucose (IFG) which is known to be an early stage of diabetes mellitus.

Materials and Methods:

The study was performed in our Hospital. The files of a total of 184 male patients aged greater than 18 years old presenting to urology outpatient clinics with complaint of ED and  a control group of male patients presenting to internal medicine outpatient clinic with a other (no ED) complaining within 3 months period between October 2017 and December 2017 were included in the screening. Ages, genders and FBG levels of the patients were noted. We aimed to show ED could be taken into consideration as a prediabetes symptom or as a first sign of diabetes by measuring FBG levels. According to the IDF 2015 data, those with FBG of 100-125 were considered to have IFG, and those with IFG >126 mg/dl it was accepted as a DM. NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) program was used for the statistical analysis.

Ethic statement

All participants provided written informed consent for participation in the study. The study was approved by Hospital Ethics Committee. All procedures were conducted in accordance with criteria of Ethic Standard Committee on Human Research and Declaration of Helsinki.


A total of 184 people were considered with the systematic random sampling method. All of the patients were males. Mean age of the patients was 45.78±10.3 (Table 1). Mean fasting blood glucose level was measured to be 133,7±77,3 mg/dL at the group of ED complaining and 102,7±24,3 mg/dL at the control group without ED complaining. There was  significantly associated  between IFG and ED (p<0,05) (Table 2).


It is known that there is DM in the etiology of ED. It is considered from the previous studies performed that ED can be among first symptoms of coronary artery disease [9]. In this study, we assessed the presence of IFG and its association with ED.

The risk for development of type 2 DM in the population with IFG between 3 and 5 years is 51.3%. The risk for development of type 2 DM in the population with IFG and IGT within 5 years is 33-36%. Prediabetes is seen in 25-62% of patients with idiopathic peripheral neuropathy and neuropathy is seen in 13-21% of the population with impaired glucose tolerance [10].

ED occurs in consequence of the development of autonomic neuropathy in diabetic patients [11]. Neuropathy present in IFG and early DM is phenotypically similar. In IFG, neuropathy is present in 30-50% of patients with IGT and similarly in about 40% of early diabetics, suggesting early involvement of neuropathy. Between 25 and 62% of patients with idiopathic peripheral neuropathy are prediabetes; 13% to 21% in IGT patients also has neuropathic findings. 11-25% of patients with prediabetes have peripheral neuropathy. Neuropathic pain has been reported in 13 to 21% of patients [12].

Duration of diabetes has been shown to  significantly correlate with the erectile function score patient with a history of DM longer than 10 years three times more likely to develop ED as those with a history of less than 5 years [13].  There is also increasing evidence that ED is significantly associated with the level of glycemic control. Mean fasting blood glucose level was measured to be 133,7±77,3 mg/dL  at the group of ED complaining and 102,7±24,3 mg/dL at the control group without ED complaining. ED is more common in men with IFG than in general population.

ED, one of the neuropathic complications, occurs over time in more than 50% of IGT patients and 10-18% of diabetic population. Metabolic tissue damage caused by hyperglycemia is responsible for microvascular complications [13, 14, 15]. Therefore, the IFG should be actively sought in men who are complaining of ED [16]. Similar results have been observed in other studies, ED is not only independently associated with undiagnosed DM, it is also associated with IFG [17].

It is considered that ED in dysglycemia develops due to atherosclerosis and neuropathic changes in the corporal erectile tissue. These alterations may include changes such as smooth muscle degeneration, endothelial cell dysfunction and abnormal collagen deposition [17]. Autonomic neuropathy causes impaired endothelium-dependent and independent vasodilatation without clinical macrovascular symptom. Undiagnosed autonomic neuropathy increases the risk of ED in peripheral neuropathy. In case of stress condition occurring as a result of interaction between endothelial dysfunction and autonomic neuropathy, adequate blood flow can not be provided [18]. This condition is an important marker for screening of the patients in regards to silent coronary artery disease (CAD) [19].

IFG is only a clinical presumptive diagnosis, not a real clinical entity. It must be monitored for the long term and necessary precautions should be taken regarding DM. Available data suggest that there is a lower risk for progression of IFG to diabetes and macrovascular disease rather than IGT [15]. In this study, it was observed that the rates of IFG and IGT were higher in the patients with a complaint of ED. Similarly, it was shown also in the previous studies [17, 20, 21].

Olafimihan study shows that IFG was statistically associated with ED (about 60% of this group had ED). Similar results have been reported by other studies in the literature (Grover et al. 2006). IGT, such as IFG, are not a clinical entity, they are a risk category with earlier medical presentations such as advanced diabetes and / or cardiovascular disease.

The impact of ED on social life is very important. Especially the number of patients in developing or underdeveloped countries is low due to sexual taboos. Only 10 percent of men between the ages of 18 and 60 in Turkey, apply to doctor with ED  complaint. In our study the control group wasn’t ask for this kind of complaint, so maybe this percent is more than we found it.

In this study IFG was statistically associated with ED (almost 54.3% of this group had a ED). IFG is risk categories for future diabetes and or CAD with much earlier medical presentation such as ED [23,24].

These findings have important clinical implications for physicians to ask questions about sexual health that lead to screening of these risk groups and to make a change to prevent the progress of the disease.


ED can be taken into consideration as an early neuropathic symptom in prediabetic or as a early sign of diabetes patients. Healthcare professionals should ask questions about sexual health for the screening of these groups and it is needed for taking necessary precautions before causing important clinical consequences.


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Table 1: Distribution of Demographic Characteristics





n (%)

92(%50)92 (%50)
Fasting blood glucose (FBG)




Table 2: Erectile dysfunction in dysglycemia.


VariableNo EDEDp
Fasting blood glucose (FBG)n1 (%)n2(%) 







Normoglycemic (<100mg/dL)53 (%28.8)41 (%22.3)
Impaired fasting glucose (IFG)

(100-126 mg/dL)


39 (%21.1)


51 (%27.8)

By Padraic D. McCahill, M.D.On: May 03, 2019 at 14:38:55