Erectile Dysfunction in Diabetics Frequently Neglected

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NEW ORLEANS—Diabetic men with erectile dysfunction (ED) frequently fail to discuss the condition with their physician, and physicians often neglect to query their patients about possible ED, according to study findings released here at the 69th Scientific Sessions of the American Diabetes Association.

Data showed that 56% of men attending a diabetes clinic reported that they had never been asked whether they had ED and nearly half of men with ED had never sought help for their complaint. Most diabetic men in the study population had ED.

“We were surprised to learn how many diabetic men actually had ED and … how poor we doctors are at screening for it,” said Ana Rakovac Tisdall, MD, Endocrinology Research Registrar at Connolly Hospital in Dublin, Ireland.

“When I interviewed men presenting to our clinic about their diabetes-related complications, I routinely asked them if they had ED since that's what I was taught to do by my first diabetes consultant. However, I started noticing that none of my younger colleagues [was] doing that.”

Dr. Tisdall said she was disheartened by the fact that diabetic patients were not being routinely queried about possible ED. “I felt that this was an important issue to address. Many men told me that ED had ruined their lives, destroyed their marriages, and so on.”

Even after the diabetes clinic where she works implemented routine ED screening, only 70 (56%) of 124 male patients attending the clinic were screened for the condition, Dr. Tisdall reported. Of these, 49 (70%) reported ED.

Scores on the International Index of Erectile Function (IIEF) questionnaire completed by men who had reported ED showed the condition to be severe in about a fourth of cases. Patients with ED tended to be older, to have had diabetes longer, and to use ACE inhibitors more often than those without ED.

Of 60 ED patients who completed an IIEF questionnaire, 39 (65%) had not been asked about ED by a medical professional since they had been diagnosed with diabetes.

The results also revealed that about 40% of men with ED had never initiated a discussion of their ED with a medical professional.

In about a third of cases, men said they were too embarrassed. About a fourth of men said they had not discussed ED because they were not bothered by it. “We didn't tease out this information so we can't say [if] they were not bothered because they were not in a relationship or not sexually active,” Dr. Tisdall said.

The remaining patients said they didn't discuss ED with a health-care professional because they considered it to be a normal part of the aging process or normal for diabetes or their physician was a woman.

Physicians' reasons for not asking patients about ED included forgetting to ask, lack of time, and thinking it was inappropriate.

“I think physicians need to include questions about ED as part of their annual review in diabetic men much in the same way we ask them about vision complications, numbness or tingling in their fingers, and so on,” Dr. Tisdall said.

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