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Open Access 01-06-2017 | Article

Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study

Authors: Shazli Azmi, Maryam Ferdousi, Uazman Alam, Ioannis N. Petropoulos, Georgios Ponirakis, Andrew Marshall, Omar Asghar, Hassan Fadavi, Wendy Jones, Mitra Tavakoli, Andrew J. M. Boulton, Maria Jeziorska, Handrean Soran, Nathan Efron, Rayaz A. Malik

Published in: Diabetologia | Issue 6/2017

Abstract

Aims/hypothesis

The aim of this study was to identify the contribution of small- and large-fibre neuropathy to erectile dysfunction in men with type 1 diabetes mellitus.

Methods

A total of 70 participants (29 without and 41 with erectile dysfunction) with type 1 diabetes and 34 age-matched control participants underwent a comprehensive assessment of large- and small-fibre neuropathy.

Results

The prevalence of erectile dysfunction in participants with type 1 diabetes was 58.6%. After adjusting for age, participants with type 1 diabetes and erectile dysfunction had a significantly higher score on the Neuropathy Symptom Profile (mean ± SEM 5.3 ± 0.9 vs 1.8 ± 1.2, p = 0.03), a higher vibration perception threshold (18.3 ± 1.9 vs 10.7 ± 2.4 V, p = 0.02), and a lower sural nerve amplitude (5.0 ± 1.1 vs 11.7 ± 1.5 mV, p = 0.002), peroneal nerve amplitude (2.1 ± 0.4 vs 4.7 ± 0.5 mV, p < 0.001) and peroneal nerve conduction velocity (34.8 ± 1.5 vs 41.9 ± 2.0 m/s, p = 0.01) compared with those without erectile dysfunction. There was also evidence of a marked small-fibre neuropathy with an impaired cold threshold (19.7 ± 1.4°C vs 27.3 ± 1.8°C, p = 0.003), warm threshold (42.9 ± 0.8°C vs 39.0 ± 0.9°C, p = 0.005) and heart rate variability (21.5 ± 3.1 vs 30.0 ± 3.7 beats/min, p = 0.001) and reduced intraepidermal nerve fibre density (2.8 ± 0.7 vs 5.9 ± 0.7/mm, p = 0.008), corneal nerve fibre density (12.6 ± 1.5 vs 23.9 ± 2.0/mm², p < 0.001), corneal nerve branch density (12.7 ± 2.5 vs 31.6 ± 3.3/mm², p < 0.001) and corneal nerve fibre length (8.3 ± 0.7 vs 14.5 ± 1.0 mm/mm², p < 0.001) in participants with type 1 diabetes and erectile dysfunction. Erectile dysfunction correlated significantly with measures of both large- and small-fibre neuropathy.

Conclusions/interpretation

Small-fibre neuropathy is prominent in patients with type 1 diabetes, and is associated with erectile dysfunction and can be objectively quantified using corneal confocal microscopy. This may allow the identification of patients who are less likely to respond to conventional therapies such as phosphodiesterase type 5 inhibitors.

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Title: Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study
Authors: Shazli Azmi
Maryam Ferdousi
Uazman Alam
Ioannis N. Petropoulos
Georgios Ponirakis
Andrew Marshall
Omar Asghar
Hassan Fadavi
Wendy Jones
Mitra Tavakoli
Andrew J. M. Boulton
Maria Jeziorska
Handrean Soran
Nathan Efron
Rayaz A. Malik
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: Diabetologia / Issue 6/2017
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-017-4245-z

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