Diabetic peripheral neuropathy (DPN) substantially increases the risk for erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men with long-standing type 1 diabetes (T1D), according to a study in Diabetes Care.

Researchers sought to assess the association between DPN and urological complications in patients with long-standing T1D enrolled in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Intervention and Complications (EDIC) study.

A total of 635 men (mean age, 51.6 years; diabetes duration, 29.5 years) and 371 women (mean age, 50.6 years; diabetes duration, 29.8 years) were included in an ancillary study (UroEDIC) with the goal of focusing on urological complications noted in the larger DCCT/EDIC study. Diabetic peripheral neuropathy evaluations were conducted at EDIC year 13 or 14 with assessments of symptoms, clinical signs, and electrophysiology. Annual EDIC examinations began in 1994 and ended in 2010 (EDIC year 17).


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At EDIC year 17, 30% of men reported ED only, 10% had LUTS only, and 15% had both ED and LUTS. Among women, 25% reported female sexual dysfunction (FSD) only, 18% had LUTS/urinary incontinence (UI) only, and 16% had both FSD and LUTS/UI.

In men, the odds of ED and LUTS vs no ED or LUTS at EDIC year 17 were 3.52 (95% CI, 1.69, 7.31) times greater in those with confirmed DPN at EDIC year 13/14 than in those without confirmed DPN, after adjusting for factors such as age, drinking status, body mass index, hypertension, statin use and several others. Also, men who had abnormal Michigan Neuropathy Screening Instrument examinations or questionnaire scores had significantly higher odds of ED and LUTS vs no ED or LUTS at EDIC year 17 than men without DPN. In comparison, there were no significant differences in DPN between women reporting both FSD and LUTS/UI compared to those without FSD or LUTS/UI at EDIC year 17.

The researchers noted several limitations of the study, including the lack of ED/LUTS and FSD/UI assessments in association with the full battery of confirmed DPN assessments. Additionally, 198 women who reported no sexual activity were excluded from the analysis. Researchers also noted that a lack of racial diversity in the study population limits the generalizability of the study findings, as well as to people with type 2 diabetes (T2D).

“Sex-related variation in these urological complications and their underlying mechanisms may explain some of these divergent findings,” stated the investigators. “Future studies confirming the associations between DPN and development and progression of sexual and urinary dysfunction in other cohorts with T1D  and T2D are warranted.”

Disclosure: Some pharmaceutical and medical device companies provided free or discounted supplies or equipment to participants in the study. Please see the original reference for a full list of disclosures.

Reference

Pop-Busui R, Braffett BH, Wessells H, et al. Diabetic peripheral neuropathy and urological complications in type 1 diabetes: findings from the Epidemiology of Diabetes Interventions and Complications study. Diabetes Care. Published online November 2, 2021. doi:10.2337/dc21-1276