title: Diabetes severity, metabolic syndrome, and the risk of erectile dysfunction.
abstract: BACKGROUND
  Erectile dysfunction (ED) is more common in men with type 2 diabetes mellitus (T2DM), obesity, and/or the metabolic syndrome (MetS).
  
  
  OBJECTIVE
  The aim of this study is to investigate the associations among proxy measures of diabetic severity and the presence of MetS with ED in a nationally representative U.S. data sample.
  
  
  METHODS
  We performed a cross-sectional analysis of adult participants in the 2001-2004 National Health and Nutrition Examination Survey.
  
  
  METHODS
  ED was ascertained by self-report. T2DM severity was defined by calculated measures of glycemic control and insulin resistance (IR). IR was estimated using fasting plasma insulin (FPI) levels and the homeostasis model assessment of IR (HOMA-IR) definition. We classified glycemic control using hemoglobin-A1c (HbA1c) and fasting plasma glucose (FPG) levels. MetS was defined by the American Heart Association and National Heart, Lung, and Blood Institute criteria. Logistic regression models, adjusted for sociodemographics, risk factors, and comorbidities, were fitted for each measure of T2DM severity, MetS, and the presence of ED.
  
  
  RESULTS
  Proxy measures of glycemic control and IR were associated with ED. Participants with FPG between 100-126 mg/dL (5.6-7 mmol/L) and ≥ 126 mg/dL (>7 mmol/L) had higher odds of ED, odds ratio (OR) 1.22 (confidence interval or CI, 0.83-1.80), and OR 2.68 (CI, 1.48-4.86), respectively. Participants with HbA1c 5.7-6.4% (38.8-46.4 mmol/mol) and ≥ 6.5% (47.5 mmol/mol) had higher odds of ED (OR 1.73 [CI, 1.08-2.76] and 3.70 [CI, 2.19-6.27], respectively). When FPI and HOMA-IR were evaluated by tertiles, there was a graded relation among participants in the top tertile. In multivariable models, a strong association remained between HbA1c and ED (OR 3.19 [CI,1.13-9.01]). MetS was associated with >2.5-fold increased odds of self reported ED (OR 2.55 [CI, 1.85-3.52]).
  
  
  CONCLUSIONS
  Poor glycemic control, impaired insulin sensitivity, and the MetS are associated with a heightened risk of ED.
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Aviva E
authors.initials: AE
authors.lastname: Weinberg
authors.forename: Michael
authors.initials: M
authors.lastname: Eisenberg
authors.forename: Chirag J
authors.initials: CJ
authors.lastname: Patel
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: John T
authors.initials: JT
authors.lastname: Leppert
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D007172:Erectile Dysfunction / Q000453:epidemiology*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000097:blood; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes Mellitus; Diabetes Severity; Endothelial Dysfunction; Erectile Dysfunction; Insulin Resistance; Men's Health; Metabolic Syndrome