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Objective

There is a lack of studies addressing response to PDE5i in men with prediabetes (PreDM). We assessed the response to PDE5i in men with normo-glycaemia, DM and PreDM seeking first medical help for erectile dysfunction (ED).

Methods

ED patients with PreDM depicted lower rates of response to PDE5i than euglycaemic men. These Results suggest that even milder forms of glucose impairment are associated with impaired efficacy of ED therapy. However, only DM emerged as an independent predictor for impaired treatment response.

Results

Overall, 196 (56.7%), 81 (23.5%) and 69 (19.7%) patients had normo-glycaemia (=controls), PreDM and DM, respectively. Diabetic and PreDM men were older (all p<0.001), had higher BMI (all p<0.02) and CCI scores (all p<0.01) and lower total testosterone (tT) (all p<0.04) than controls. Median IIEF-EF was lower both in DM (10.0 vs. 18.0; p<0.001) and in PreDM (14.0 vs. 18.0; p<0.001) than in controls. IIEF-EF improved in all groups after treatment (all p<0.001). Controls more frequently reached significant MCID than PreDM and DM patients (65.3% vs. 22.9% vs. 11.8%). IIEF-EF scores were higher in controls than PreDM and DM men after treatment (26.0 vs. 20.0 vs. 17.5; all p<0.01). Multivariable logistic regression analysis showed that age (OR 0.96, p<0.001), baseline IIEF-EF score (OR 0.94, p<0.001), and +DM (OR 0.37, p=0.02) were independent predictors of MCID, after accounting for BMI, CCI and tT.

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