title: Erectile and endothelial dysfunction in Type II diabetes: a possible link.
abstract: 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.
authors.affiliation: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: De Angelis
authors.forename: M A
authors.initials: MA
authors.lastname: Marfella
authors.forename: M
authors.initials: M
authors.lastname: Siniscalchi
authors.forename: L
authors.initials: L
authors.lastname: Marino
authors.forename: F
authors.initials: F
authors.lastname: Nappo
authors.forename: F
authors.initials: F
authors.lastname: Giugliano
authors.forename: D
authors.initials: D
authors.lastname: De Lucia
authors.forename: D
authors.initials: D
authors.lastname: Giugliano
mesh_terms: 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
chemical_list: D001120:Arginine; D015815:Cell Adhesion Molecules; D006442:Glycated Hemoglobin; D018799:Intercellular Adhesion Molecule-1; D019007:P-Selectin; D018180:Thrombomodulin