Clinical, Socioeconomic, and Lifestyle Parameters Associated With Erectile Dysfunction Among Diabetic Men

Pathophysiology/Complications

¹Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel
²Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
³Diabetes Unit, Wolfson Medical Center, Holon, Israel
⁴Information and Computer Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel
⁵Department of Internal Medicine C and the Diabetes Unit, Soroka University Medical Center, Beer-Sheba, Israel
⁶Unit of Biostatistics, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel
⁷Diabetes Unit, Hadasa Medical Center, Jerusalem, Israel

Address correspondence and reprint requests to Ofra Kalter-Leibovici, Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, 52621, Israel. E-mail: ofrak{at}post.tau.ac.il

Diabetes Care 2005 Jul; 28(7): 1739-1744. https://doi.org/10.2337/diacare.28.7.1739

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Figure 1—
Erectile function by age (A) and diabetes duration (B). ED, erectile dysfunction.

Table 1—

Associations between demographic, lifestyle, and diabetes-related characteristics and erectile function

	Total	Normal erectile function	Mild erectile dysfunction	Mild to moderate erectile dysfunction	Moderate erectile dysfunction	Severe erectile dysfunction	P
n (%)	1,040 (100)	140 (13.5)	216 (20.8)	193 (18.5)	178 (17.1)	313 (30.1)	—
Patients’ characteristics
Age (years)	57.0 ± 11.8	47.6 ± 11.8	52.8 ± 11.3	57.3 ± 9.1	59.0 ± 10.2	62.6 ± 10.9	<0.0001
Region/country of birth
Asia/Africa	19.9	9.0	20.5	25.3	22.3	20.1	—
Europe/America	33.5	32.3	31.0	29.3	32.5	38.7	0.0078
Israel	46.6	58.6	48.4	45.4	45.2	41.2	—
Currently employed*	70.3	85.4	77.4	67.3	65.2	57.0	<0.0001
Blue-collar profession	30.0	20.2	24.1	32.0	38.6	33.2	0.0044
Number of pack-years (median)†	12.55	4.0	11.0	12.65	16.5	17.5	0.0168
Any alcohol consumption	20.4	29.4	21.4	19.0	20.7	16.3	0.0361
Physically active							<0.0001
None	33.8	27.7	26.2	26.5	34.7	45.7	—
Leisure time	26.5	28.5	28.1	25.9	22.3	27.3	—
At work	16.2	15.3	18.1	20.1	14.7	13.8	—
Both	23.5	28.5	27.6	27.5	28.2	13.2	—
BMI (kg/m²)	28.5 ± 4.4	28.0 ± 4.1	28.5 ± 4.5	28.6 ± 4.5	28.5 ± 4.2	28.8 ± 4.5	0.50
Characteristics of diabetes and its complications
Median diabetes duration (years)	8	5	7	8	9	12	<0.0001
Type 1 diabetes	12.1	25.7	15.4	8.8	11.2	6.1	<0.0001
Current A1C (median)	7.7	7.6	7.3	7.6	7.9	7.8	0.0176
Any microvascular complications	50.1	37.1	38.4	47.7	55.6	62.3	<0.0001
Ischemic heart disease	20.0	5.1	11.4	20.9	22.0	30.6	<0.0001
CVD	24.8	6.6	13.4	26.3	27.1	38.4	<0.0001

Data are the means ± SD or %, unless otherwise indicated.
*
↵* Patient’s age is <65 years;
†
↵† 1 pack-year = smoking one pack of cigarettes per day for 1 year. One pack contains 20 cigarettes. BMI is calculated as body weight (kg) divided by height squared (m²).

Table 2—

Associations between hypertension, antihypertension therapy, hyperlipidemia, and erectile function

Variable	Total	Normal erectile function	Mild erectile dysfunction	Mild to moderate erectile dysfunction	Moderate erectile dysfunction	Severe erectile dysfunction	P
n (%)	1,040 (100)	140 (13.5)	216 (20.8)	193 (18.6)	178 (17.1)	313 (30.1)	—
Hypertension and antihypertension drug therapy
Systolic blood pressure (mmHg)	134.1 ± 18.8	128.3 ± 15.3	132.5 ± 18.9	135.2 ± 19.5	133.2 ± 17.2	137.5 ± 20.0	0.0001
Hypertension*	440 (43.0)	36 (26.5)	81 (38.6)	78 (40.6)	77 (43.7)	168 (54.4)	<0.0001
Subjects on diuretics	103 (9.9)	6 (4.3)	19 (8.8)	9 (4.7)	14 (7.9)	55 (17.6)	<0.0001
Subjects on β-adrenergic receptor blockers	155 (14.9)	5 (3.6)	39 (18.1)	27 (14.0)	26 (14.6)	58 (18.5)	0.0007
Subjects on Calcium channel antagonists	164 (15.8)	11 (7.9)	26 (12.0)	23 (11.9)	28 (15.7)	76 (24.3)	<0.0001
Subjects on ACE inhibitors or angiotensin receptor antagonists	487 (46.8)	50 (35.7)	93 (43.1)	93 (48.2)	85 (47.7)	166 (53.0)	0.0102
Plasma lipid levels and hyperlipidemia
Total cholesterol (mmol/l)	4.9 ± 1.0	4.8 ± 0.9	4.9 ± 1.0	5.0 ± 1.1	5.0 ± 1.2	4.9 ± 1.0	0.64
LDL cholesterol (mmol/l)	3.0 ± 0.8	2.9 ± 0.8	2.9 ± 0.7	3.0 ± 0.9	2.9 ± 0.9	2.9 ± 0.8	0.81
Triglyceride level (median) (mmol/l)	1.7	1.3	1.5	1.8	1.8	1.9	0.0017
HDL cholesterol (mmol/l)	1.1 ± 0.3	1.1 ± 0.3	1.1 ± 0.3	1.1 ± 0.3	1.1 ± 0.3	1.1 ± 0.3	0.32
Hyperlipidemia*	56.1	45.2	51.4	56.0	59.3	62.3	0.0077

Table 3—

Attributes significantly associated with erectile dysfunction in multivariate analysis

Variable	P	Odds ratio (95% CI)
Patients’ characteristics
Age (10-year increments)	<0.0001	1.81 (1.57–2.09)
Physical activity (reference category: none)
Work related	0.57	0.79 (0.54–1.16)
Leisure time	0.98	0.74 (0.53–1.03)
Both types	0.0009	0.50 (0.35–0.71)
Any alcohol consumption (reference category: none)	0.0326	0.70 (0.51–0.97)
Clinical characteristics
Diabetes duration (5-year increments)	<0.0001	1.20 (1.10–1.31)
A1C (1% increment)	0.0368	1.09 (1.01–1.18)
Any microvascular complications	0.0199	1.39 (1.05–1.83)
Cardiovascular disease	0.0008	1.80 (1.28–2.54)
Diuretics	0.0135	1.87 (1.14–3.08)