title: Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes.
abstract: OBJECTIVE
  We determined whether intensive glycemic therapy reduces the risk of erectile dysfunction in men with type 1 diabetes enrolled in the Diabetes Control and Complications Trial.
  
  
  METHODS
  The Diabetes Control and Complications Trial randomized 761 men with type 1 diabetes to intensive or conventional glycemic therapy at 28 sites between 1983 and 1989, of whom 366 had diabetes for 1 to 5 years and no microvascular complications (primary prevention cohort), and 395 had diabetes for 1 to 15 years with nonproliferative retinopathy or microalbuminuria (secondary intervention cohort). Subjects were treated until 1993, and followed in the Epidemiology of Diabetes Interventions and Complications study. In 2003 we conducted an ancillary study using a validated assessment of erectile dysfunction in 571 men (80% participation rate), 291 in the primary cohort and 280 in the secondary cohort.
  
  
  RESULTS
  Of the participants 23% reported erectile dysfunction. The prevalence was significantly lower in the intensive vs conventional treatment group in the secondary cohort (12.8% vs 30.8%, p = 0.001) but not in the primary cohort (17% vs 20.3%, p = 0.49). The risk of erectile dysfunction in primary and secondary cohorts was directly associated with mean HbA1c during the Diabetes Control and Complications Trial, and Epidemiology of Diabetes Interventions and Complications combined. Age, peripheral neuropathy and lower urinary tract symptoms were other risk factors.
  
  
  CONCLUSIONS
  A period of intensive therapy significantly reduced the prevalence of erectile dysfunction 10 years later among those men in the secondary intervention cohort but not in the primary prevention cohort. Higher HbA1c was significantly associated with risk in both cohorts. These findings provide further support for early implementation of intensive insulin therapy in young men with type 1 diabetes.
authors.affiliation: Department of Urology and Diabetes Endocrinology Research Center, University of Washington School of Medicine, Seattle, Washington, USA. wessells@u.washington.edu
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Patricia
authors.initials: P
authors.lastname: Cleary
authors.forename: Brandy N
authors.initials: BN
authors.lastname: Rutledge
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
authors.forename: David S
authors.initials: DS
authors.lastname: Schade
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Sarma
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy*; D007172:Erectile Dysfunction / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin