Diabetes, Obesity and Erectile Dysfunction: Field Overview and Research Priorities

Purpose

We provide an overview of basic, clinical and epidemiological research in the field of erectile dysfunction and important research priorities presented at the 2009 National Institute of Diabetes and Digestive and Kidney Diseases symposium on Urological Complications of Diabetes and Obesity.

Materials and Methods

Experts in molecular biology, physiology, pharmacology, clinical trials, epidemiology and urological surgery highlighted current knowledge on erectile dysfunction associated with diabetes mellitus and obesity.

Results

Predictable associations between erectile dysfunction, and poor diabetic control and modifiable risk factors, including body mass index, have not yet been translated into randomized trials in the United States. The relationship between erectile dysfunction and metabolic syndrome, and surrogate markers for erectile dysfunction requires further investigation. Basic research aimed at discovering disease mechanisms and therapeutic targets has focused on autonomic neuropathy, vascular dysfunction, smooth muscle contractile function and matrix. However, significant gaps exist in regard to the integration of molecular, cellular and functional data. Animal models of type 2 diabetes and obesity associated erectile dysfunction require investigation because most basic science studies have used rodent models of type 1 diabetes.

Conclusions

Studies are needed to synthesize a systems biology understanding of erectile function/dysfunction, and characterize and disseminate rodent models of erectile dysfunction associated with type 2 diabetes and obesity. Clinical studies are needed of promising intervention and prevention strategies. Leveraging existing and future cohort phenotypes, and biological samples is needed for risk factor analysis, biomarker discovery and genome wide association studies.

Key Words: penis, impotence, diabetes, obesity, epidemiology

Abbreviations and Acronyms: BMI, body mass index, CRP, C-reactive protein, ED, erectile dysfunction, IIEF, International Index of Erectile Function domain, IIEF-EF, IIEF-erectile function, MMAS, Massachusetts Male Aging Study, NO, nitric oxide, PDE5-I, phosphodiesterase type 5 inhibitor, T1D, type 1 diabetes, T2D, type 2 diabetes, ZDF, Zucker rat