Erectile and endothelial dysfunction in Type II diabetes: a possible link.
OBJECTIVE
The aim of this study was to evaluate the relation between erectile dysfunction and endothelial functions, coagulation activation, peripheral and autonomic neuropathy in men with Type II (non-insulin-dependent) diabetes mellitus.


METHODS
We studied 30 Type II diabetic patients with symptomatic erectile dysfunction and 30 potent diabetic patients matched for age and disease. Endothelial functions were assessed with the L-arginine test, plasma thrombomodulin and cell adhesion molecules circulating concentrations. Haemostasis was evaluated with markers of thrombin activation and fibrinolysis. Quantitative sensory testing (vibratory, warming, and heat-pain thresholds), cardiovascular reflex tests and 24-h blood pressure monitoring were used to assess peripheral or autonomic neuropathy.


RESULTS
Mean erectile score and HbA1c were 10.5+/-5.8 and 8.3+/-1.6% in patients with erectile dysfunction, and 24.0+/-0.7 and 6.8+/-1.4% in those without erectile dysfunction, respectively (p < 0.001); there was a significant relation between HbA1c and erectile function score in patients with erectile dysfunction (r = -0.45, p = 0.02). The decrease in blood pressure and platelet aggregation in response to L-arginine was lower (p < 0.05-0.02) in patients with erectile dysfunction, whereas soluble thrombomodulin, P-selectin and intercellular cell ahhesion molecule-1 concentrations were higher (p < 0.05-0.02). Indices of coagulation activation (F1 + 2 and D-dimers) and reduced fibrinolysis (PAI-1) were also found to be higher in erectile dysfunction patients. Heat-pain and warm perception thresholds. as well as cardiovascular reflex tests, were most commonly abnormal in patients with erectile dysfunction (p < 0.05). In multivariate analysis, HbA1c, MBP response to L-arginine, P-selectin, indices of coagulation, and quantitative sensory testing were independent predictors of erectile function score.


CONCLUSIONS
Erectile dysfunction in diabetic men correlates with endothelial dysfunction. A reduced nitric oxide activity might provide a unifying explanation.
De Angelis
L
L
Department of Geriatrics and Metabolic Diseases, Second University of Naples, Italy.
Marfella
M A
MA
Siniscalchi
M
M
Marino
L
L
Nappo
F
F
Giugliano
F
F
De Lucia
D
D
Giugliano
D
D
D001120:Arginine; D001777:Blood Coagulation; D001794:Blood Pressure / Q000187:drug effects; D015815:Cell Adhesion Molecules / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D007172:Erectile Dysfunction / Q000150:complications*; D005342:Fibrinolysis; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D010974:Platelet Aggregation / Q000187:drug effects; D018180:Thrombomodulin / Q000097:blood
D001120:Arginine; D015815:Cell Adhesion Molecules; D006442:Glycated Hemoglobin; D018799:Intercellular Adhesion Molecule-1; D019007:P-Selectin; D018180:Thrombomodulin