Top

12-03-2024 | Erectile Dysfunction | Original Article

Association between erectile dysfunction and subjective well-being in primary care patients with type 2 diabetes

Authors: Hazem A. Sayed Ahmed, Ehaab Mahmoud Abdallah, Mohamed Abd Elwahed Mohamed, Tamis Mohamed Aboelfotoh, Hebatallah Nour-Eldein, Ahmed Mahmoud Fouad

Published in: Diabetology International

Abstract

Objectives

To assess the association between erectile dysfunction and subjective well-being among primary care patients with type 2 diabetes mellitus.

Methods

This cross-sectional study included 340 men with type 2 diabetes treated in primary health care settings in the Ismailia governorate between April 2021 and April 2022. A multistage random cluster sampling technique was used. Sociodemographic data, disease characteristics, lifestyle, surgical and sexual history, and the Arabic translations of the abridged 5-item version of the International Index of Erectile Function (IIEF-5) Questionnaire, and the 5-item World Health Organization Well-Being Index (WHO-5) were gathered.

Results

Erectile dysfunction was identified in 72.94% of diabetic patients, with 55% mild or mild-to-moderate (ED I), and 17.9% moderate or severe (ED II). Twenty percent had Poor subjective well-being, with a mean WHO-5 index of 63.4 (± 15.4). Binary logistic regression analysis showed that education, diabetes duration, insufficient income, dyslipidemia, benign prostate hyperplasia, and IIEF-5 score were significantly associated with poor subjective well-being. Increasing IIEF-5 score was significantly associated with a 22% decrease in the odds of poor subjective well-being (OR: 0.78; 95% CI 0.66–0.93). Multinomial regression analysis showed that increasing score of the WHO-5 well-being index was associated with a 11% and 14% reduction in the odds of ED I and II, respectively (OR: 0.89 (95% CI 0.86–0.93), and 0.86 (95% CI 0.81–0.92), respectively).

Conclusion

Erectile dysfunction and subjective well-being were interrelated. Early detection of erectile dysfunction is essential for improving the positive mental health of men with type 2 diabetes in primary care.

International Diabetes Federation. IDF Diabetes Atlas—10th Edition. Brussels, Belgium: International Diabetes Federation; 2021. http://www.diabetesatlas.org/. Accessed 6 May 2022.

Altun I, Demirhan Y, Erkek Y, Peker A, Çetinarslan B. Subjective well-being of persons with type 2 diabetes mellitus. Popul Health Manag. 2014;17(4):253–4. https://doi.org/10.1089/pop.2014.0013.CrossRefPubMed

Holmes-Truscott E, Browne JI, Pouwer F, Speight J, Cummins RA. Subjective wellbeing among adults with diabetes: results from diabetes MILES—Australia. J Happiness Stud. 2016;17:1205–17. https://doi.org/10.1007/s10902-015-9638-4.CrossRef

Ruggeri K, Garcia-Garzon E, Maguire Á, Matz S, Huppert FA. Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries. Health Qual Life Outcomes. 2020;18(1):192. https://doi.org/10.1186/s12955-020-01423-y.CrossRefPubMedPubMedCentral

Zanuso S, Balducci S, Jimenez A. Physical activity, a key factor to quality of life in type 2 diabetic patients. Diabetes Metab Res Rev. 2009;25(Suppl 1):S24–8. https://doi.org/10.1002/dmrr.984.CrossRefPubMed

Diener E, Chan MY. Happy people live longer: subjective well-being contributes to health and longevity. Appl Psychol Health Well Being. 2011;3(1):1–43. https://doi.org/10.1111/j.1758-0854.2010.01045.x.CrossRef

Papanas N, Tsapas A, Papatheodorou K, Papazoglou D, Bekiari E, Sariganni M, et al. Glycaemic control is correlated with well-being index (WHO-5) in subjects with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2010;118(6):364–7. https://doi.org/10.1055/s-0029-1243623.CrossRefPubMed

Ramkisson S, Pillay BJ, Sartorius B. Anxiety, depression and psychological well-being in a cohort of South African adults with type 2 diabetes mellitus. S Afr J Psychiatr. 2016;22(1):935. https://doi.org/10.4102/sajpsychiatry.v22i1.935.CrossRefPubMedPubMedCentral

Mirahmadizadeh A, Mahizadeh H, Seif M, Sharifi MH. Factors related to psychological well-being amongst patients with type 2 diabetes. Diabetes Res Clin Pract. 2021;178: 108982. https://doi.org/10.1016/j.diabres.2021.108982.CrossRefPubMed

10.

Speight J, Hendrieckx C, Pouwer F, Skinner TC, Snoek FJ. Back to the future: 25 years of “Guidelines for encouraging psychological well-being” among people affected by diabetes. Diabet Med. 2020;37(8):1225–9. https://doi.org/10.1111/dme.14165.CrossRefPubMed

11.

Kizilay F, Gali HE, Serefoglu EC. Diabetes and sexuality. Sex Med Rev. 2017;5(1):45–51. https://doi.org/10.1016/j.sxmr.2016.07.002.CrossRefPubMed

12.

McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, et al. Definitions of sexual dysfunctions in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016;13(2):135–43. https://doi.org/10.1016/j.jsxm.2015.12.019.CrossRefPubMed

13.

Kouidrat Y, Pizzol D, Cosco T, Thompson T, Carnaghi M, Bertoldo A, et al. High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet Med. 2017;34(9):1185–92. https://doi.org/10.1111/dme.13403.CrossRefPubMed

14.

Salama N. Sexual dysfunctions as self-reported by diabetic-type-2 men: an andrology clinic-based study in Alexandria. Egypt Am J Med Biol Res. 2013;1(3):50–7. https://doi.org/10.12691/ajmbr-1-3-1.CrossRef

15.

Ghanem YM, Zahran ARM, Younan DN, Zeitoun MH, El Feky AY. Prevalence of erectile dysfunction among Egyptian male patients with type 2 diabetes mellitus. Diabetes Metab Syndr. 2021;15(3):949–53. https://doi.org/10.1016/j.dsx.2021.04.019.CrossRefPubMed

16.

el-Rufaie OE, Bener A, Abuzeid MS, Ali TA. Sexual dysfunction among type II diabetic men: a controlled study. J Psychosom Res. 1997;43(6):605–12. https://doi.org/10.1016/s0022-3999(97)00183-9.CrossRefPubMed

17.

Al-Hunayan A, Al-Mutar M, Kehinde EO, Thalib L, Al-Ghorory M. The prevalence and predictors of erectile dysfunction in men with newly diagnosed with type 2 diabetes mellitus. BJU Int. 2007;99(1):130–4. https://doi.org/10.1111/j.1464-410X.2006.06550.x.CrossRefPubMed

18.

El-Sakka AI. Erectile dysfunction in Arab countries. Part I: prevalence and correlates. Arab J Urol. 2012;10(2):97–103. https://doi.org/10.1016/j.aju.2012.01.004.CrossRefPubMedPubMedCentral

19.

AlMogbel TA. Erectile dysfunction and other sexual activity dysfunctions among saudi type 2 diabetic patients. Int J Health Sci (Qassim). 2014;8(4):347–59.PubMedPubMedCentral

20.

Lo WH, Fu SN, Wong CK, Chen ES. Prevalence, correlates, attitude and treatment seeking of erectile dysfunction among type 2 diabetic Chinese men attending primary care outpatient clinics. Asian J Androl. 2014;16(5):755–60. https://doi.org/10.4103/1008-682X.127823.CrossRefPubMedPubMedCentral

21.

Russo GI, Cimino S, Fragalà E, Privitera S, La Vignera S, Condorelli R, et al. Insulin resistance is an independent predictor of severe lower urinary tract symptoms and of erectile dysfunction: results from a cross-sectional study. J Sex Med. 2014;11(8):2074–82. https://doi.org/10.1111/jsm.12587.CrossRefPubMed

22.

Castela Â, Costa C. Molecular mechanisms associated with diabetic endothelial-erectile dysfunction. Nat Rev Urol. 2016;13(5):266–74. https://doi.org/10.1038/nrurol.2016.23.CrossRefPubMed

23.

Santi D, Granata AR, Guidi A, Pignatti E, Trenti T, Roli L, et al. Six months of daily treatment with vardenafil improves parameters of endothelial inflammation and of hypogonadism in male patients with type 2 diabetes and erectile dysfunction: a randomized, double-blind, prospective trial. Eur J Endocrinol. 2016;174(4):513–22. https://doi.org/10.1530/EJE-15-1100.CrossRefPubMed

24.

Gianatti EJ, Grossmann M. Testosterone deficiency in men with type 2 diabetes: pathophysiology and treatment. Diabet Med. 2020;37(2):174–86. https://doi.org/10.1111/dme.13977.CrossRefPubMed

25.

Maalmi H, Herder C, Bönhof GJ, Strassburger K, Zaharia OP, Rathmann W, et al. Differences in the prevalence of erectile dysfunction between novel subgroups of recent-onset diabetes. Diabetologia. 2022;65(3):552–62. https://doi.org/10.1007/s00125-021-05607-z.CrossRefPubMed

26.

Defeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, et al. Erectile dysfunction and diabetes: a melting pot of circumstances and treatments. Diabetes Metab Res Rev. 2022;38(2): e3494. https://doi.org/10.1002/dmrr.3494.CrossRefPubMed

27.

Ma RC, So WY, Yang X, Yu LW, Kong AP, Ko GT, et al. Erectile dysfunction predicts coronary heart disease in type 2 diabetes. J Am Coll Cardiol. 2008;51(21):2045–50. https://doi.org/10.1016/j.jacc.2008.02.051.CrossRefPubMed

28.

Batty GD, Li Q, Czernichow S, Neal B, Zoungas S, Huxley R, ADVANCE Collaborative Group, et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial. J Am Coll Cardiol. 2010;56(23):1908–13. https://doi.org/10.1016/j.jacc.2010.04.067.CrossRefPubMedPubMedCentral

29.

García-Malpartida K, Mármol R, Jover A, Gómez-Martínez MJ, Solá-Izquierdo E, Victor VM, et al. Relationship between erectile dysfunction and silent myocardial ischemia in type 2 diabetic patients with no known macrovascular complications. J Sex Med. 2011;8(9):2606–16. https://doi.org/10.1111/j.1743-6109.2011.02365.x.CrossRefPubMed

30.

Chen S, Peng D, Xu X, Gao J, Dai F, Zuo C, et al. Assessment of erectile dysfunction and associated psychological distress in Chinese men with type 2 diabetes mellitus. Int J Impot Res. 2017;29(5):210–4. https://doi.org/10.1038/ijir.2017.25.CrossRefPubMed

31.

Bąk E, Marcisz C, Krzemińska S, Dobrzyn-Matusiak D, Foltyn A, Drosdzol-Cop A. Relationships of sexual dysfunction with depression and acceptance of illness in women and men with type 2 diabetes mellitus. Int J Environ Res Public Health. 2017;14(9):1073. https://doi.org/10.3390/ijerph14091073.CrossRefPubMedPubMedCentral

32.

De Berardis G, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, Kaplan SH, et al. Erectile dysfunction and quality of life in type 2 diabetic patients: a serious problem too often overlooked. Diabetes Care. 2002;25(2):284–91. https://doi.org/10.2337/diacare.25.2.284.CrossRefPubMed

33.

Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60. https://doi.org/10.3758/BRM.41.4.1149.CrossRefPubMed

34.

Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319–26. https://doi.org/10.1038/sj.ijir.3900472.CrossRefPubMed

35.

Shamloul R, Ghanem H, Abou-zeid A. Validity of the Arabic version of the sexual health inventory for men among Egyptians. Int J Impot Res. 2004;16(5):452–5. https://doi.org/10.1038/sj.ijir.3901248.CrossRefPubMed

36.

Hajos TR, Pouwer F, Skovlund SE, Den Oudsten BL, Geelhoed-Duijvestijn PH, Tack CJ, et al. Psychometric and screening properties of the WHO-5 well-being index in adult outpatients with type 1 or type 2 diabetes mellitus. Diabet Med. 2013;30(2):e63–9. https://doi.org/10.1111/dme.12040.CrossRefPubMed

37.

Sibai AM, Chaaya M, Tohme RA, Mahfoud Z, Al-Amin H. Validation of the Arabic version of the 5-item WHO Well Being Index in elderly population. Int J Geriatr Psychiatry. 2009;24(1):106–7. https://doi.org/10.1002/gps.2079.CrossRefPubMed

38.

American Diabetes Association. Standards of medical care in diabetes—2020 abridged for primary care providers. Clin Diabetes. 2020;38(1):10–38. https://doi.org/10.2337/cd20-as01.CrossRefPubMedCentral

39.

Zeleke M, Hailu D, Daka D. Erectile dysfunction and associated factors among diabetic patients at, Hawassa, Southern, Ethiopia. BMC Endocr Disord. 2021;21(1):139. https://doi.org/10.1186/s12902-021-00807-5.CrossRefPubMedPubMedCentral

40.

Ugwu T, Ezeani I, Onung S, Kolawole B, Ikem R. Predictors of erectile dysfunction in men with type 2 diabetes mellitus referred to a tertiary healthcare centre. Adv Endocrinol. 2016;2016(8):1–8. https://doi.org/10.1155/2016/9753154.CrossRef

41.

Mulhall JP, Giraldi A, Hackett G, Hellstrom WJG, Jannini EA, Rubio-Aurioles E, et al. The 2018 revision to the process of care model for evaluation of erectile dysfunction. J Sex Med. 2018;15(9):1280–92. https://doi.org/10.1016/j.jsxm.2018.06.005.CrossRefPubMed

42.

Malavige LS, Jayaratne SD, Kathriarachchi ST, Sivayogan S, Ranasinghe P, Levy JC. Erectile dysfunction is a strong predictor of poor quality of life in men with type 2 diabetes mellitus. Diabet Med. 2014;31(6):699–706. https://doi.org/10.1111/dme.12412.CrossRefPubMed

43.

Li C, Xia Y, Zhang Y. Relationship between subjective well-being and depressive disorders: novel findings of cohort variations and demographic heterogeneities. Front Psychol. 2023;13:1022643. https://doi.org/10.3389/fpsyg.2022.1022643.CrossRefPubMedPubMedCentral

44.

De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, et al. Clinical and psychological predictors of incidence of self-reported erectile dysfunction in patients with type 2 diabetes. J Urol. 2007;177(1):252–7. https://doi.org/10.1016/j.juro.2006.08.102.CrossRefPubMed

45.

Giugliano F, Maiorino M, Bellastella G, Gicchino M, Giugliano D, Esposito K. Determinants of erectile dysfunction in type 2 diabetes. Int J Impot Res. 2010;22(3):204–9. https://doi.org/10.1038/ijir.2010.1.CrossRefPubMed

46.

Furukawa S, Sakai T, Niiya T, Miyaoka H, Miyake T, Yamamoto S, et al. Depressive symptoms and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: the Dogo Study. Int J Impot Res. 2017;29(2):57–60. https://doi.org/10.1038/ijir.2016.45.CrossRefPubMed

47.

Vasconcelos P, Paúl C, Serruya SJ, Ponce de León RG, Nobre P. A systematic review of sexual health and subjective well-being in older age groups. Rev Panam Salud Publica. 2022;46:e179. https://doi.org/10.26633/RPSP.2022.179.CrossRefPubMedPubMedCentral

48.

Chuang YC, Chung MS, Wang PW, Lee WC, Chen CD, Chang HW, et al. Albuminuria is an independent risk factor of erectile dysfunction in men with type 2 diabetes. J Sex Med. 2012;9(4):1055–64.CrossRefPubMed

49.

Sayed Ahmed HA, Fouad AM, Elotla SF, Joudeh AI, Mostafa M, Shah A, et al. Prevalence and associated factors of diabetes distress, depression and anxiety among primary care patients with type 2 diabetes during the COVID-19 pandemic in Egypt: a cross-sectional study. Front Psychiatry. 2022;13: 937973. https://doi.org/10.3389/fpsyt.2022.937973.CrossRefPubMedPubMedCentral

50.

McLeish AC, Smith T, Riggs DW, Hart JL, Walker KL, Keith RJ, et al. Community-based evaluation of the associations between well-being and cardiovascular disease risk. J Am Heart Assoc. 2022;11(22): e027095. https://doi.org/10.1161/JAHA.122.027095.CrossRefPubMedPubMedCentral

51.

Kim MT, Kim KB, Ko J, Jang Y, Levine D, Lee HB. Role of depression in diabetes management in an ethnic minority population: a case of Korean Americans with type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5(1): e000337. https://doi.org/10.1136/bmjdrc-2016-000337.CrossRefPubMedPubMedCentral

52.

Malavige LS, Jayaratne SD, Kathriarachchi ST, Sivayogan S, Fernando DJ, Levy JC. Erectile dysfunction among men with diabetes is strongly associated with premature ejaculation and reduced libido. J Sex Med. 2008;5(9):2125–34.CrossRefPubMed

53.

Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, Maggi M. Interplay between premature ejaculation and erectile dysfunction: a systematic review and meta-analysis. J Sex Med. 2015;12(12):2291–300.CrossRefPubMed

54.

Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male. 2019;22(1):12–9.CrossRefPubMed

55.

Chung RY, Leung JC, Chan DC, Woo J, Wong CK, Wong SY. Lower urinary tract symptoms (LUTS) as a risk factor for depressive symptoms in elderly men: results from a large prospective study in Southern Chinese men. PLoS ONE. 2013;8(9): e76017. https://doi.org/10.1371/journal.pone.0076017.ADSCrossRefPubMedPubMedCentral

56.

Dunphy C, Laor L, Te A, Kaplan S, Chughtai B. Relationship between depression and lower urinary tract symptoms secondary to benign prostatic hyperplasia. Rev Urol. 2015;17(2):51–7. https://doi.org/10.3909/riu0658.CrossRefPubMedPubMedCentral

57.

Jeong WS, Choi HY, Nam JW, Kim SA, Choi BY, Moon HS, et al. Men with severe lower urinary tract symptoms are at increased risk of depression. Int Neurourol J. 2015;19(4):286–92. https://doi.org/10.5213/inj.2015.19.4.286.CrossRefPubMedPubMedCentral

Title: Association between erectile dysfunction and subjective well-being in primary care patients with type 2 diabetes
Authors: Hazem A. Sayed Ahmed
Ehaab Mahmoud Abdallah
Mohamed Abd Elwahed Mohamed
Tamis Mohamed Aboelfotoh
Hebatallah Nour-Eldein
Ahmed Mahmoud Fouad
Publication date: 12-03-2024
Publisher: Springer Nature Singapore
Keywords: Erectile Dysfunction
Type 2 Diabetes
Dyslipidemia
Published in: Diabetology International
Print ISSN: 2190-1678
Electronic ISSN: 2190-1686
DOI: https://doi.org/10.1007/s13340-024-00699-5

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Please log in to get access to this content

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials