Young male patients presenting with erectile dysfunction should be screened for diabetes and prediabetes at presentation.

Complications from type 2 diabetes (T2D) include kidney disease, eye disease, cardiovascular and arterial disease, and neuropathy, according to Jane Tucker, MD.  “A recent meta-analysis and review revealed that each 1-year increase in age at diabetes diagnosis was associated with a 4%, 3%, and 5% increased risk for all-cause mortality, macrovascular disease, and microvascular disease, respectively,” Dr. Tucker says. “Furthermore, we know that half of men with established diabetes have erectile dysfunction (ED), which is about 3.5 times the rate of the general population.”

To gain a better understanding of the association with ED and T2D, Dr. Tucker and colleagues conducted a study aimed to determine if ED, like cardiovascular disease, is a direct risk factor for prediabetes and T2D and what the timeline would be between ED diagnosis in a patient and future diagnosis of glycemic issues. Their findings were published in Preventive Medicine.

Nearly 75% Diagnosed With T2D/Prediabetes Within a Year of ED Diagnosis.

The study team used a large database (N=231,523) of deidentified medical records. By using medical record data in retrospective cohort studies, they were able to observe the real-world process of care. “By using dates of clinic encounters/diagnoses, we were able to establish the temporal order of events to determine risk for prediabetes and T2D following a new ED diagnosis,” Dr. Tucker points out. “The clinical relevance of the study is enhanced since the analyses is based on medical record data and our observations are directly applicable to the SSM Health System patient population.”

Dr. Tucker and colleagues observed that about 30% of young adult men (aged 18-40) presenting with ED were diagnosed with T2D or prediabetes on their first visit. Nearly 75% were diagnosed with T2D or prediabetes within a year of the initial ED diagnosis. “This indicates that young male patients presenting with ED should be screened for diabetes and prediabetes at presentation,” Dr. Tucker says. “In addition, they need to be followed closely as they are at high risk for developing diabetes or prediabetes over the next few years. There are many opportunities to receive treatment for ED where ongoing follow-up including regular screening for diabetes is not part of usual care. Patients should be informed of their increased risk, and blood sugar surveillance should be part of their ongoing treatment plan.” She adds that these patients should have an ongoing relationship with a primary care physician who can monitor them on a regular basis.

Time Lag Is Short to the Onset of a Diabetes Diagnosis

“The time lag is very short to the onset of diagnosis,” Dr. Tucker notes. “However, this presents an opportunity to offer preventative care for these individuals who may not know that they are at increased risk (Figure).”

Physicians and other healthcare professionals who treat young male patients should screen for diabetes for those who present with ED and continue to follow them every 6 to 12 months with rescreening if the initial screening is negative, according to the study team. “Earlier identification and treatment for young men with diabetes has the potential to reduce their higher lifetime burden of morbidity and mortality,” Dr. Tucker adds.

In the future, Dr. Tucker and colleagues hope that this high predictive value of ED for T2D in young men can add to data used to study the pathophysiology of ED. “We would like to look more closely at race as it relates to age of onset for ED and diabetes in younger men,” Dr. Tucker says. “This would allow us to reach out to specific groups who may be at higher risk. Lastly, we hope that endocrinologists, primary care physicians, urologists, endocrinologist, and men’s health groups are motivated to continue to closely follow young men presenting with ED so as not to miss the opportunity for timely and early intervention in the prevention and treatment of diabetes.”