Diabetes has long been considered the number one risk factor for erectile dysfunction, and a new analysis of past research finds the sexual disorder is extremely common among men with diabetes, afflicting some 53 per cent.
The study of data on nearly 90,000 men found those with diabetes are three and a half times more likely than men without the disease to have difficulty maintaining an erection, according to the report in Diabetic Medicine.
Because erectile dysfunction can be a sign of the often silent cardiovascular issues that go along with diabetes, doctors should take the sexual complaint as a cue to screen for both diabetes and heart disease, the study team writes.
"Erectile dysfunction, due to its evident presentation, can play a crucial role in early diabetes mellitus diagnosis and acts as an alarm bell for other silent complications," said study coauthor Dr. Damiano Pizzol, coordinator of the Operational Research Unit of Doctors with Africa Cuamm in Beira, Mozambique.
Since 1980, the number of people with diabetes worldwide has soared from 108 million to 422 million, the study team writes, and the prevalence among adults has increased from 4.7 per cent to 8.5 per cent.
Although erectile dysfunction is most common in men over age 40, it can occur at any age alongside diabetes and heart disease, they note.
"Too often, the lack of prevention, an unhealthy diet and lack of physical exercise leads to a late diagnosis of diabetes," Pizzol told Reuters Health by email. Many times, he added, complications like erectile dysfunction lead to the initial diabetes diagnosis.
The researchers analysed 145 studies that included 88,577 men to understand how common erectile dysfunction is with diabetes. Most of the studies were conducted in Asia and Europe, and half focused only on men with type 2 diabetes, the more common form of the disease that's associated with age and obesity.
The research team found that overall, 37.5 per cent of men with type 1 diabetes and 66.3 per cent of those with type 2 diabetes had erectile dysfunction. Rates varied significantly across countries and were highest in South America and lowest in North America.
Erectile dysfunction also developed about 10 to 15 years earlier in men with diabetes compared to men without the disease.
"Raising awareness of erectile dysfunction and other related men's health issues would encourage a much-needed discussion, which is often overlooked or even avoided by patients and health care professionals," said Dr. Laith Alzweri, a urology fellow at Tulane University School of Medicine in New Orleans who wasn't involved in the study.
"Erectile function could be viewed as an indirect parameter of a man's general well-being, both mental and physical," Alzweri told Reuters Health by email.
In addition to screening for diabetes when men complain of erectile dysfunction as the study authors recommend, screening for erectile dysfunction by health care professionals should be part of the routine assessment of diabetic men, he said.
A major limitation of the analysis is that only a quarter of the studies included information about complications associated with diabetes. Also, studies included in the analysis could vary in the diagnosis of erectile dysfunction, the type of diabetes, diagnosis of complications, diabetes health care offerings and insurance coverage, especially across countries, said Dr. Zdravko Kamenov of Alexandrovska University Hospital in Sofia, Bulgaria, who wasn't involved in the study.
"The large regional variations are intriguing," he told Reuters Health by email. "Cultural, psychological and other factors could affect the reported rates of erectile dysfunction."
Diabetes is estimated to reach 322 million cases worldwide by 2025, and erectile dysfunction is cited as the third most frequent complication of diabetes, he noted.
Future studies should focus on other long-term diabetes risk factors associated with erectile dysfunction, such as smoking and length of diagnosis. The exact hormonal, physical and psychological connections between diabetes and erectile dysfunction could also point researchers toward new treatment options, Kamenov said.
"Erectile function is a window to men's health," he added. "In most cases, one question is enough to open the window."