What is the relationship between erectile dysfunction (ED) and diabetes mellitus (DM)?

From the Guidelines

Erectile dysfunction in diabetic men should be treated with PDE5 inhibitors, such as sildenafil, tadalafil, or vardenafil, as first-line therapy, due to their high efficacy and safety rates, as shown in a study published in Diabetes/Metabolism Research and Reviews in 2011 1. The treatment of erectile dysfunction (ED) in diabetic men typically begins with lifestyle modifications, including better blood sugar control, weight loss, regular exercise, smoking cessation, and limiting alcohol consumption.

• First-line medication therapy usually involves PDE5 inhibitors, which enhance blood flow to the penis but require sexual stimulation to work.
• The most commonly used PDE5 inhibitors are sildenafil (Viagra) 50-100mg taken 1 hour before sexual activity, tadalafil (Cialis) 10-20mg as needed or 2.5-5mg daily, vardenafil (Levitra) 10-20mg, or avanafil (Stendra) 100-200mg.
• If PDE5 inhibitors are ineffective, alternatives include vacuum erection devices, intracavernosal injections like alprostadil (5-40mcg), intraurethral suppositories, or penile implants for severe cases.
• ED in diabetes occurs due to a combination of vascular damage from high blood sugar, nerve damage (neuropathy), hormonal imbalances, and psychological factors.
• Regular monitoring of blood glucose levels (aiming for HbA1c below 7%) is essential as improved glycemic control can help prevent worsening of ED, as suggested by a study published in the Annals of Internal Medicine in 2009 1.
• Patients should discuss potential medication interactions with their healthcare provider, particularly if taking nitrates, which are contraindicated with PDE5 inhibitors due to dangerous blood pressure drops, as recommended by the American College of Physicians in 2009 1.

From the FDA Drug Label

Tadalafil for once daily use was shown to be effective in treating ED in patients with diabetes mellitus. Patients with diabetes were included in both studies in the general ED population (N=79) A third randomized, multicenter, double-blinded, placebo-controlled, parallel-arm design trial included only ED patients with type 1 or type 2 diabetes (N=298). In this third trial, tadalafil demonstrated clinically meaningful and statistically significant improvement in erectile function, as measured by the EF domain of the IIEF questionnaire and Questions 2 and 3 of the SEP diary

Erectile dysfunction in diabetes can be treated with tadalafil.

• Tadalafil has been shown to be effective in treating ED in patients with diabetes mellitus.
• The drug has demonstrated clinically meaningful and statistically significant improvement in erectile function in patients with diabetes.
• Tadalafil can be used to treat ED in patients with type 1 or type 2 diabetes 2.
• Another study also showed that vardenafil (LEVITRA) is effective in treating ED in patients with diabetes mellitus 3.

From the Research

Treatment Options for Erectile Dysfunction in Diabetes

• Phosphodiesterase type 5 inhibitors (PDE5i) are considered the first-line therapy for erectile dysfunction (ED) in patients with diabetes mellitus (DM) 4, 5, 6, 7.
• Testosterone replacement therapy (TRT) is recommended for hypogonadal patients with ED and diabetes 5.
• Intracavernosal injections and vacuum constriction devices are safe and effective treatment options for ED in diabetic patients 4, 8.
• Penile prostheses can be considered for patients with refractory ED, but poor glycometabolic control can increase the risk of infection 4, 5, 8.

Pathophysiology and Risk Factors

• The pathophysiology of ED in diabetes is multifactorial, involving endothelial dysfunction, specific complications of diabetes, and psychological factors 8.
• ED is a potential marker to screen for silent coronary artery disease in diabetic patients 8.
• Optimal glycaemic control, management of associated co-morbidities, and lifestyle modifications are essential in the management of ED in diabetes 4, 5, 8.

Pharmacotherapeutic Strategies

• Oral PDE5 inhibitors, such as sildenafil, tadalafil, and vardenafil, have been shown to be effective in the treatment of ED in diabetic patients 6, 7.
• The use of hypoglycemic drugs, such as glucagon-like peptide type 1 analogues or sodium glucose cotransporter-2 inhibitors, can help optimize glycometabolic control and reduce the risk of cardiovascular complications 5.
• Metformin can be considered a possible alternative for less complicated subjects 5.