title: Cardiovascular autonomic neuropathy, erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes: findings from the DCCT/EDIC.
abstract: OBJECTIVE
  We evaluated the association between cardiovascular autonomic neuropathy, and erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes.
  
  
  METHODS
  Male type 1 diabetes participants (635) in the DCCT/EDIC were studied. Cardiovascular autonomic neuropathy was assessed by standardized cardiovascular reflex tests including changes in respiratory rate variation with deep breathing, Valsalva maneuver (Valsalva ratio) and changes in supine to standing diastolic blood pressure. Erectile dysfunction was assessed by a proxy item from the International Index of Erectile Function, and lower urinary tract symptoms were assessed with the AUASI (American Urological Association Symptom Index). Multivariable logistic regression models estimated the association between cardiovascular autonomic neuropathy and erectile dysfunction and/or lower urinary tract symptoms, adjusting for time weighted glycemic control, blood pressure, age and other covariates.
  
  
  RESULTS
  Men in whom erectile dysfunction and/or lower urinary tract symptoms developed during EDIC had a significantly lower respiratory rate variation and Valsalva ratio at DCCT closeout and EDIC year 16/17 compared to those without erectile dysfunction or lower urinary tract symptoms. In adjusted analysis, participants with cardiovascular autonomic neuropathy had 2.65 greater odds of erectile dysfunction and lower urinary tract symptoms (95% CI 1.47-4.79).
  
  
  CONCLUSIONS
  These data suggest that cardiovascular autonomic neuropathy predicts the development of urological complications in men with long-standing type 1 diabetes. Studies evaluating the mechanisms contributing to these interactions are warranted for targeting effective prevention or treatment.
authors.affiliation: Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop-Busui
authors.affiliation: Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah.
authors.forename: Jim
authors.initials: J
authors.lastname: Hotaling
authors.affiliation: Biostatistics Center, George Washington University, Rockville, Maryland.
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Braffett
authors.affiliation: Biostatistics Center, George Washington University, Rockville, Maryland.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.affiliation: Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Martin
authors.affiliation: Research Institute, Winthrop-University Hospital, Mineola, New York.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jacobson
authors.affiliation: Department of Urology and Diabetes Endocrinology Research Center, University of Washington, Seattle, Washington.
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan. Electronic address: asarma@umich.edu.
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Sarma
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy; D003929:Diabetic Neuropathies / Q000209:etiology*; D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology*; D008297:Male; D008875:Middle Aged
keywords: diabetes mellitus; erectile dysfunction; hereditary sensory and autonomic neuropathies; lower urinary tract symptoms