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Diabetes Care 28:2637-2643, 2005
© 2005 by the American Diabetes Association, Inc.

Epidemiology/Health Services/Psychosocial Research
Original Article

Longitudinal Assessment of Quality of Life in Patients With Type 2 Diabetes and Self-Reported Erectile Dysfunction

Giorgia De Berardis, MSCPHARMCHEM, Fabio Pellegrini, MSCSTAT, Monica Franciosi, MSCBIOLS, Maurizio Belfiglio, MD, Barbara Di Nardo, HSDIP, Sheldon Greenfield, MD, Sherrie H. Kaplan, PHD, MPH, Maria C.E. Rossi, MSCPHARMCHEM, Michele Sacco, MD, Gianni Tognoni, MD, Miriam Valentini, MD, Antonio Nicolucci, MD on behalf of the QuED (Quality of Care and Outcomes in Type 2 Diabetes) Study Group*

Address correspondence and reprint requests to Antonio Nicolucci, MD, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale 8/A, 66030 S. Maria Imbaro (CH), Italy. E-mail: nicolucci{at}negrisud.it

OBJECTIVE—In the context of the QuED (Quality of Care and Outcomes in Type 2 Diabetes) project, we evaluated the longitudinal changes over 3 years in quality of life (QoL) in patients with type 2 diabetes according to the presence or the development of erectile dysfunction (ED).

RESEARCH DESIGN AND METHODS—Patients were requested to fill in a questionnaire investigating the presence of ED and QoL (SF-36 Health Survey, depression symptoms [Center for Epidemiologic Studies–Depression], and quality of sexual life) every 6 months for 3 years. The analyses were based on multilevel models, adjusted for patient clinical and sociodemographic characteristics.

RESULTS—The study involved 1,456 patients, of whom 34% reported frequent erectile problems at baseline; 192 developed ED during the follow-up. No changes in QoL measures were detected in patients without ED; in those with ED at baseline, a worsening in all SF-36 scales was observed, reaching statistical significance for physical functioning (P = 0.03). Among patients who developed ED during the study, a deterioration in all SF-36 dimensions and a worsening in depressive symptoms preceded the development of ED. The onset of ED was associated with a further marked worsening in physical functioning (P = 0.0008), general health perception (P = 0.02), and social functioning (P = 0.04) on SF-36 subscales, as well as in the summary physical and mental components scores (P = 0.04 and P = 0.07, respectively). The development of ED was also associated with a highly significant increase in depressive symptoms (P = 0.001) and a marked decrease in quality of sexual life (P < 0.0001).

CONCLUSIONS—This longitudinal study documents for the first time the impact of ED onset on several aspects of QoL in patients with type 2 diabetes. The study also shows that QoL tended to further decrease during 3 years in patients with ED at baseline but not in those without this condition.

Abbreviations: CES-D, Center for Epidemiologic Studies–Depression • CVD, cardiovascular disease • ED, erectile dysfunction • QoL, quality of life • TIBI, Total Illness Burden Index


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