Erectile dysfunction (ED) in men with diabetes mellitus (DM) may require more aggressive treatment than ED in men without diabetes, data suggest.

In a study of 136,306 men with ED, diabetic men were 55% more likely to be prescribed second-line ED treatments (penile suppositories or injectables) and 2.1 times more likely to be prescribed third-line therapies (penile prostheses) than non-diabetic men within five years of ED diagnosis, investigators reported in the International Journal of Impotence Research.

The study population included 19,236 men (14%) who had diabetes prior to their ED diagnosis and 117,070 men without diabetes. Results showed that 2.8% of the diabetics were prescribed second-line ED therapies compared with 1.8% of the non-diabetics.

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The study findings suggest that ED among diabetic men may be less responsive to first-line pharmacologic treatments, may worsen more rapidly, or both, according to the researchers.

“These data are particularly important given that the incidence of diabetes is rising in the United States,” the researchers, led by Thomas J. Walsh, MD, of the University of Washington in Seattle, wrote. “The increased severity of ED in men with diabetes may lead to higher health-care utilization, and thus appropriate resource allocation and policy regarding coverage may require reassessment.”

Despite some study limitations, the investigators noted, “the novel finding of a significantly more progressive and less responsive course for ED in men with DM argues for earlier and possibly more aggressive interventions in men with DM.”

For the study, Dr. Walsh’s group used insurance claim data to identify men with ED and followed claims for 48 months. “Claims-based data analysis allows us to single out men with severe ED by assessing their use of sequentially more invasive therapeutic modalities,” the authors stated. “This makes it a potentially innovative tool for examining the progression of ED over time and the severity of ED in different sub-populations of men without the need for expensive urology or ED-specific longitudinal cohort studies.”