Erectile Dysfunction Should Trigger Diabetes Screening

Laurie Barclay, MD

July 21, 2015

Erectile dysfunction (ED) is a marker of undiagnosed diabetes, according to results from a cross-sectional survey published in the July/August issue of the Annals of Family Medicine. The findings suggest ED should be a trigger to begin diabetes screening, especially in middle-aged men.

"Identifying easily observable risk factors associated with undiagnosed cardiometabolic risk factors, particularly in men, may improve early diagnosis and subsequent treatment," write Sean C. Skeldon, MD, from the Centre for Health Services and Policy Research, School of Population and Public Health, the University of British Columbia, Vancouver, Canada, and colleagues.

"Over the past decade, evidence has suggested that [ED] is an early indicator for cardiovascular disease."

Using data from male participants aged 20 years and older in the National Health and Nutrition Examination Survey from 2001 to 2004, the investigators analyzed whether ED was associated with undiagnosed cardiometabolic risk factors.

Logistic regression analyses allowed assessment of the relationship between ED, identified by a single, validated survey question, and undiagnosed hypertension, hypercholesterolemia, and diabetes.

The likelihood of undiagnosed diabetes was more than double in men with ED than in men without ED, after multivariate adjustment (odds ratio, 2.20; 95% confidence interval, 1.10 - 4.37). However, the survey did not detect any association of ED with undiagnosed hypertension or undiagnosed hypercholesterolemia. The predicted probability of having undiagnosed diabetes at age 40 to 59 years was 1 in 10 for men with ED compared with to 1 in 50 for men without ED.

In the fasting glucose analytic sample, the prevalence of undiagnosed diabetes was 11.5% in men with ED compared with 2.8% in men without ED. The difference was most dramatic in men aged 40 to 59 years, in whom the prevalence of undiagnosed diabetes was 19.1% among men with ED and 3.3% among men without ED.

"[M]en with [ED], particularly those who are middle-aged, should be made aware of their potential for having underlying diabetes and be encouraged to obtain screening," the study authors write. "In the same vein, physicians should be vigilant in obtaining sexual histories in middle-aged men and screening those with [ED] for diabetes."

The authors note several study limitations, including possible underreporting of ED, possibly altered screening practices of physicians who were aware of the significance of ED as a marker, and a cross-sectional design, which precludes determination of the temporal relationship between ED and the undiagnosed risk factors.

"Although we observed significant associations between undiagnosed diabetes and more traditional cardiovascular risk factors, [ED] is unique because of its common symptomatology and available treatment options," the authors conclude. "As such, it can act as a useful incentive for men to access the health care system and be readily screened."

Some of the study authors reported receiving funding support from the Canadian Institutes of Health Research, the Western Regional Training Centre for Health Services Research, the Stephen Jarislowski Chair in Urologic Sciences at Vancouver General Hospital, the Michael Smith Foundation for Health Research, and/or Health Canada.

Ann Fam Med. 2015;13:331-335. Full text

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