The Journal of Urology
Volume 182, Issue 6, Supplement , Pages S45-S50 , December 2009

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

  • Kanchan Chitaley
  • ,
  • Varant Kupelian
  • ,
  • Leslee Subak
  • ,
  • Hunter Wessells

      Affiliations

    • Corresponding Author InformationCorrespondence: Department of Urology, University of Washington, 1959 Pacific Ave. Northeast, Box 356510, Seattle, Washington 98104 (telephone: 206-731-3205; FAX: 206-731-4709)
    • Financial interest and/or other relationship with PNN Medical and American Medical Systems.

References 

  1. Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26:917
  2. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549
  3. Saigal CS, Wessells H, Pace J, et al. Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med. 2006;166:207
  4. Brown JS, Wessells H, Chancellor MB, et al. Urologic complications of diabetes. Diabetes Care. 2005;28:177
  5. Chitaley K: Type 1 and type 2 diabetic-erectile dysfunction: same diagnosis (ICD-9), different disease? J Sex Med, suppl., 1009; 6: 262.
  6. Bacon CG, Hu FB, Giovannucci E, et al. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care. 2002;25:1458
  7. Johannes CB, Araujo AB, Feldman HA, et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol. 2000;163:460
  8. Fedele D, Coscelli C, Santeusanio F, et al. Erectile dysfunction in diabetic subjects in Italy (Gruppo Italiano Studio Deficit Erettile nei Diabetici). Diabetes Care. 1998;21:1973
  9. Klein R, Klein BE, Moss SE. Ten-year incidence of self-reported erectile dysfunction in people with long-term type 1 diabetes. J Diabetes Compl. 2005;19:35
  10. Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294:2996
  11. Ma RC, So WY, Yang X, et al. Erectile dysfunction predicts coronary heart disease in type 2 diabetes. J Am Coll Cardiol. 2008;51:2045
  12. Kupelian V, Shabsigh R, Araujo AB, et al. Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study. J Urol. 2006;176:222
  13. Araujo AB, Travison TG, Ganz PA, et al. Erectile dysfunction as a predictor of coronary heart disease in aging men: prospective results from the Massachusetts Male Aging Study. J Urol. 2006;175(suppl.):427;abstract 1326
  14. Corona G, Mannucci E, Petrone L, et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res. 2006;18:190
  15. El-Sakka AI, Sayed HM, Tayeb KA. Type 2 diabetes-associated androgen alteration in patients with erectile dysfunction. Int J Androl. 2008;31:602
  16. Corona G, Mannucci E, Petrone L, et al. NCEP-ATPIII-defined metabolic syndrome, type 2 diabetes mellitus, and prevalence of hypogonadism in male patients with sexual dysfunction. J Sex Med. 2007;4:1038
  17. Kapoor D, Clarke S, Channer KS, et al. Erectile dysfunction is associated with low bioactive testosterone levels and visceral adiposity in men with type 2 diabetes. Int J Androl. 2007;30:500
  18. Goldstein I, Young JM, Fischer J, et al. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care. 2003;26:777
  19. Rendell MS, Rajfer J, Wicker PA, et al. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial (Sildenafil Diabetes Study Group). JAMA. 1999;281:421
  20. Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007;1:CD002187
  21. Wessells H, Penson DF, Cleary P, et al. Prevalence and predictors of sexual dysfunction in men with type 1 diabetes enrolled in DCCT/EDIC. In: June 10–14, 2005;Presented at annual meeting of American Diabetes Association, San Diego, California
  22. Khatana SA, Taveira TH, Miner MM, et al. Does cardiovascular risk reduction alleviate erectile dysfunction in men with type II diabetes mellitus?. Int J Impot Res. 2008;20:501
  23. Kolotkin RL, Binks M, Crosby RD, et al. Obesity and sexual quality of life. Obes (Silver Spring). 2006;14:472
  24. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291:2978
  25. Dallal RM, Chernoff A, O'Leary MP, et al. Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg. 2008;207:859
  26. Kaukua J, Pekkarinen T, Sane T, et al. Health-related quality of life in obese outpatients losing weight with very-low-energy diet and behaviour modification—a 2-y follow-up study. Int J Obes Relat Metab Disord. 2003;27:1233
  27. Eaton CB, Liu YL, Mittleman MA, et al. A retrospective study of the relationship between biomarkers of atherosclerosis and erectile dysfunction in 988 men. Int J Impot Res. 2007;19:218
  28. Bocchio M, Desideri G, Scarpelli P, et al. Endothelial cell activation in men with erectile dysfunction without cardiovascular risk factors and overt vascular damage. J Urol. 2004;171:1601
  29. Esposito K, Ciotola M, Giugliano F, et al. Phenotypic assessment of endothelial microparticles in diabetic and nondiabetic men with erectile dysfunction. J Sex Med. 2008;5:1436
  30. Morano S, Mandosi E, Fallarino M, et al. Antioxidant treatment associated with sildenafil reduces monocyte activation and markers of endothelial damage in patients with diabetic erectile dysfunction: a double-blind, placebo-controlled study. Eur Urol. 2007;52:1768
  31. Morano S, Gatti A, Mandosi E, et al. Circulating monocyte oxidative activity is increased in patients with type 2 diabetes and erectile dysfunction. J Urol. 2007;177:655
  32. Burnett AL, Strong TD, Trock BJ, et al. Serum biomarker measurements of endothelial function and oxidative stress after daily dosing of sildenafil in type 2 diabetic men with erectile dysfunction. J Urol. 2009;181:245
  33. National Diabetes Fact Sheet. Bethesda: Centers for Disease Control and Prevention; 2007;
  34. Kasiske BL, O'Donnell MP, Keane WF. The Zucker rat model of obesity, insulin resistance, hyperlipidemia, and renal injury. Hypertension. 1992;19(suppl.):I110
  35. Guberski DL, Butler L, Manzi SM, et al. The BBZ/Wor rat: clinical characteristics of the diabetic syndrome. Diabetologia. 1993;36:912
  36. Vernet D, Cai L, Garban H, et al. Reduction of penile nitric oxide synthase in diabetic BB/WORdp (type I) and BBZ/WORdp (type II) rats with erectile dysfunction. Endocrinology. 1995;136:5709
  37. Kawano K, Hirashima T, Mori S, et al. Spontaneous long-term hyperglycemic rat with diabetic complications (Otsuka Long-Evans Tokushima Fatty (OLETF) strain). Diabetes. 1992;41:1422
  38. Surwit RS, Kuhn CM, Cochrane C, et al. Diet-induced type II diabetes in C57BL/6J mice. Diabetes. 1988;37:1163
  39. Xie D, Odronic SI, Wu F, et al. Mouse model of erectile dysfunction due to diet-induced diabetes mellitus. Urology. 2007;70:196
  40. Sharma K, McCue P, Dunn SR. Diabetic kidney disease in the db/db mouse. Am J Physiol Renal Physiol. 2003;284:F1138
  41. Carneiro FS, Zemse S, Giachini FR, et al. TNF-alpha infusion impairs corpora cavernosa reactivity. J Sex Med. 2009;6(suppl.):311
  42. Hidalgo-Tamola J, Chitaley K. Review type 2 diabetes mellitus and erectile dysfunction. J Sex Med. 2009;6:916
  43. Disanto ME. Contractile mechanisms in diabetes-related erectile dysfunction. Curr Pharm Des. 2005;11:3995
  44. Luttrell IP, Swee M, Starcher B, et al. Erectile dysfunction in the type II diabetic db/db mouse: impaired venoocclusion with altered cavernosal vasoreactivity and matrix. Am J Physiol Heart Circ Physiol. 2008;294:H2204
  45. Carneiro FS, Giachini FR, Lima VV, et al. Adenosine actions are preserved in corpus cavernosum from obese and type II diabetic db/db mouse. J Sex Med. 2008;5:1156
  46. Wingard C, Fulton D, Husain S. Altered penile vascular reactivity and erection in the Zucker obese-diabetic rat. J Sex Med. 2007;4:348
  47. Kovanecz I, Ferrini MG, Vernet D, et al. Pioglitazone prevents corporal veno-occlusive dysfunction in a rat model of type 2 diabetes mellitus. BJU Int. 2006;98:116

PII: S0022-5347(09)01946-6

doi: 10.1016/j.juro.2009.07.089

The Journal of Urology
Volume 182, Issue 6, Supplement , Pages S45-S50 , December 2009