Should PDE5Is be prescribed routinely for all men with newly diagnosed type 2 diabetes?

Geoffrey Hackett

Abstract


Diabetes and erectile dysfunction are closely associated. It is good that there is now more awareness of the issue, especially given the strong link to heightened cardiovascular risk. This article challenges current practice and explores the routine use of phosphodiesterase inhibitors.

Full Text:

HTML PDF

References


Home P, Mant J, Diaz J, Turner C, on behalf of the Guideline Development Group. Management of type 2 diabetes: Summary of updated NICE guidance. BMJ 2008;336:1306-08. http://dx.doi.org/10.1136/bmj.39560.442095.AD

Hackett G, Cole N, Deshpande A, Popple M, Kennedy D, Wilkinson P. Biochemical hypodonadism and type 2 diabetes in primary care. Br J Diabetes Vasc Dis 2009;9:226-31. http://dx.doi.org/10.1177/1474651409342635

Hackett G, Kell P, Ralph D, et al. British Society for Sexual Medicine guidelines on the management of erectile dysfunction. J Sex Med 2008; 5:1841-6. http://dx.doi.org/10.1111/j.1743-6109.2008.00773.x

Krentz A, Mani R, Shearman C. Peripheral arterial disease in diabetes: time for co-ordinated approach to management. Br J Diabetes Vasc Dis 2003;3:92-6. http://dx.doi.org/10.1177/14746514030030020301

Rosen R, Altwein J, Boyle P, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003;44:637-49. http://dx.doi.org/10.1016/j.eururo. 2003.08.015

Doumas M, Douma S. The effect of antihypertensive drugs on erectile function: a proposed management algorithm. J Clin Hypertens 2006; 8:359-63. http://dx.doi.org/10.1111/j.1524-6175.2005.05285.x

Dhindsa S, Miller MG, McWhirter CL, et al. Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care 2010;33:1186-92. http://dx.doi.org/10.2337/dc09-1649

Hall SA, Shackleton R, Rosen RC, Araujo AB. Sexual activity, erectile dysfunction and incident cardiovascular events. Am J Cardiol 2010;105: 192-7. http://dx.doi.org/10.1016/j.amjcard.2009.08.671

Koskimaki J, Shiri J, Tammela T. Regular sexual activity protects against erectile dysfunction. The Tampere Male ageing study. Am J Med 2008;21:592-6. http://dx.doi.org/10.1016/j.amjmed. 2008.02.042

de Groot M, Anderson R, Freedland K, Clourse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001;63:619-30. http://dx.doi.org/10.1097/00006842-200107000-00015

Brooke JC, Walter DJ, Kapoor D, Marsh H, Muraleedharan V, Jones TH. Testosterone deficiency and severity of erectile dysfunction are independently associated with reduced quality of life in men with type 2 diabetes. Andrology 2014;2:205-11. http://dx.doi.org/10.1111/j.2047-2927. 2013.00177.x

NHS availability of erectile dysfunction drugs: proposed changes. https://www.gov.uk/government/consultations/nhs-availability-of-erectile-dysfunction-drugs-proposed-changes

Buvat J Montorsi F, Maggi M, et al. Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit from normalization of testosterone levels with a 1% hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). J Sex Med 2011;8:284-93. http://dx.doi.org/10.1111/j.1743-6109.2010.01956.x

Seidman SN, Roose SP, Menza MA, et al. Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001;158:1623-30. http://dx.doi.org/10.1176/appi.ajp.158.10.1623

Kirby M, Chapple C, Jackson G, et al. Erectile dysfunction and lower urinary tract symptoms: a consensus on the importance of co-diagnosis. Int J Clin Pract 2013;67:606-18. http://dx.doi.org/10.1111/ijcp.12176

Chapple CR, Roehrborn CG, McVary K. Effect of tadalafil on male lower urinary tract symptoms: an integrated analysis of storage and voiding international prostate symptom subscores from four randomised controlled trials. Eur Urol 2015;67:114-22. http://dx.doi.org/10.1016/j.eururo.2014.08.072

Gazzaruso C, Solerte SB, Pujia A, et al. Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: a potential protective role for statins and 5-phosphodiesterase inhibitors. J Am Coll Cardiol 2008;51:2040-4. http://dx.doi.org/10.1016/j.jacc.2007.10.069

Anderson SG, Hutchings DC, Kwok CS, Trafford AW, Heald AH. Phosphodiesterase type V inhibitors use in type 2 diabetes is associated with reduced all-cause mortality. Poster LB-9, ADA 2015.

Hackett GI, Heald AH, Ramachandran S. Testosterone replacement therapy and PDE5 inhibitor use are independently associated with a reduction in all-cause mortality in men with type 2 diabetes. Poster LB-7, ADA 2015.

Giannetta E, Feola T, Gianfrilli D, et al. Is chronic inhibition of phosphodiesterase type 5 cardioprotective and safe? A meta-analysis of randomized controlled trials. BMC Med 2014;12:185. http://dx.doi.org/10.1186/s12916-014-0185-321.

Guazzi M, Borglaug B. Pulmonary hypertension due to left heart disease. Circulation 2012;126:975-90. http://dx.doi.org/10.1161/CIRCULATIONAHA.111.085761

Hackett G. PDE5 inhibitors in diabetic peripheral neuropathy. Int J Clin Pract 2006;60:1123-6. http://dx.doi.org/10.1111/j.1742-1241.2006. 01087.x

Sairam K, McNicholas T. Sildenafil in diabetic peripheral neuropathy. Br J Diabetes Vasc Dis 2002;2:304. http://dx.doi.org/10.1177/14746514020020042401

Afsar B, Ortiz A, Covic A, Phosphodiesterase type 5 inhibitors and kidney disease. Int Urol Nephrol 2015;47:1521-8. http://dx.doi.org/10.1007/s11255-015-1071-4

Ramirez CE, Nian H, Yu C, et al. Treatment with sildenafil improves insulin sensitivity in prediabetes: a randomized, controlled trial. J Clin Endocrinol Metab 2015;100:4533-40. http://dx.doi.org/10.1210/jc.2015-3415




DOI: https://doi.org/10.15277/bjdvd.2015.054

Refbacks

  • There are currently no refbacks.


The Journal of the Association of British Clinical Diabetologists