title: Identifying patients with type 2 diabetes with a higher likelihood of erectile dysfunction: the role of the interaction between clinical and psychological factors.
abstract: OBJECTIVE
  We estimated the prevalence of erectile dysfunction in patients with type 2 diabetes and identified subgroups of patients in which the interaction among clinical, psychological and sociodemographic characteristics determined an increased likelihood of erectile dysfunction.
  
  
  METHODS
  The presence of erectile dysfunction was based on patient self-reporting. Clinical information was collected by participating physicians. The severity of depressive symptoms was investigated using the Center for Epidemiological Studies Depression scale. To evaluate interactions among the variables investigated and identify distinct, homogeneous subgroups of patients with different odds ratios for erectile dysfunction a tree growing technique was used.
  
  
  RESULTS
  In the 1,460 patients studied the prevalence of severe and mild-moderate erectile dysfunction was 34% and 24%, respectively. While severe erectile dysfunction was mainly related to the severity of diabetes, mild-moderate dysfunction was independent of clinical variables and only associated with the severity of depressive symptoms. The tree growing technique led to the identification of 6 classes characterized by a marked difference in the prevalence of severe erectile dysfunction of between 19% and 65%. Patients on diet alone showed the lowest prevalence of erectile dysfunction and were considered the reference category, while patients treated with insulin who had neuropathy represented the subgroup with the highest likelihood of erectile dysfunction (OR = 7.2, 95% CI 3.9 to 13.2). In patients treated with oral agents the odds ratio for erectile dysfunction was 2.7 (95% CI 1.8 to 3.9) for those with severe depressive symptoms and 1.9 (95% CI 1.3 to 2.7) for current/former smokers with low depressive symptoms. Patient age, retinopathy and cardiac-cerebrovascular disease were globally predictive variables associated with an increased likelihood of erectile dysfunction.
  
  
  CONCLUSIONS
  Our data illustrate the interplay of clinical and psychological factors in determining the risk of erectile dysfunction in type 2 diabetes and can help identify those for whom much greater attention is needed to detect erectile problems.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: De Berardis
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Monica
authors.initials: M
authors.lastname: Franciosi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Belfiglio
authors.forename: Barbara
authors.initials: B
authors.lastname: Di Nardo
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
authors.forename: Maria C E
authors.initials: MC
authors.lastname: Rossi
authors.forename: Michele
authors.initials: M
authors.lastname: Sacco
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Miriam
authors.initials: M
authors.lastname: Valentini
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D018783:Impotence, Vasculogenic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors