PURPOSE: We evaluated the association between cardiovascular autonomic neuropathy (CAN), erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in men with type 1 diabetes (T1DM).
MATERIALS & METHODS: Male T1DM participants (n=635) in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Study (DCCT/EDIC) were studied. CAN was assessed by standardized cardiovascular reflex tests including changes in R-R variation with deep-breathing, Valsalva maneuver (Valsalva ratio), and changes in supine-to-standing diastolic blood pressure. ED was assessed by a proxy item from the International Index of Erectile Function (IIEF), and LUTS by the American Urological Association Symptom Index (AUASI). Multivariable logistic regression models estimated the association between CAN, ED and/or LUTS, adjusting for time-weighted glycemic control, blood pressure, age, and other covariates.
RESULTS: Men who developed ED and/or LUTS during EDIC had significantly lower R-R variation and Valsalva ratio at DCCT closeout and EDIC year 16/17 compared to those without ED or LUTS. In adjusted analysis, participants with CAN had 2.65 greater odds of ED and LUTS (95% CI=1·47,4·79).
CONCLUSIONS: These data suggest that CAN predicts the development of urological complications in men with long-standing T1DM. Studies evaluating the mechanisms contributing to these interactions are warranted for targeting effective prevention or treatment.
Written by:
Pop-Busui R, Hotaling J, Braffett BH, Cleary PA, Dunn RL, Martin CL, Jacobson AM, Wessells H, Sarma AV. Are you the author?
University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and, Diabetes, Ann Arbor, MI 48105; University of Utah, Center for Reconstructive Urology and Men's Health University of Utah, Salt Lake City, UT 84132; George Washington University, Biostatistics Center, Rockville, MD 20852; University of Michigan, Department of Urology, Ann Arbor, MI 48109; Winthrop-University Hospital, Research Institute, Mineola, NY 11501; University of Washington, Department of Urology and Diabetes Endocrinology Research Center, Seattle, WA 98195.
Reference: J Urol. 2015 Jan 10. pii: S0022-5347(15)00014-2.
doi: 10.1016/j.juro.2014.12.097
PubMed Abstract
PMID: 25584994