Analysis Of The Correlation Between Erectile Dysfunction And Serum Free Testosterone In Men With Type 2 Diabetes Mellitus

BackgroundErectile dysfunction?ED?refers to the penile erection that is unable to achieve and maintain sexual intercourse,which affects the quality of sexual life.In recent years,studies have also found that ED can predict severe cardiovascular disease.Male erectile function is affected by tobacco and alcohol,obesity and bad lifestyle,hypertension,hyperlipidemia,psychosocial factors,surgery and trauma and many other factors.The study showed that people with diabetes had a three-fold increased risk of ED compared with non-diabetic men.Men with diabetes tend to develop ED10-15 years earlier than those without diabetes.The mechanism of ED associated with type 2 diabetes mellitus?T2DM?is not completely clear,which may be related to the increase of androgen conversion to estrogen in peripheral adipose tissue and the abnormality of testicular vascular endothelial and neurological function.As for the relationship between testosterone and diabetic ED,studies have shown that male patients with T2DM have low testosterone levels,resulting in low libido and ED.However,some clinical studies have found that there is no significant difference in testosterone between T2DM patients with and without ED.The effect of testosterone on libido is significant,but the effect on erectile function is not so obvious.In blood circulation,free testosterone?FT?can play a direct role in biological activity.However,due to the differences in the test level of various clinical institutions,the detection of FT has not yet been popularized.Most of the existing studies on diabetic ED are based on calculated free testosterone?cFT?,and the results are greatly influenced by TT and SHBG.Therefore,the correlation between ED and serum FT in male patients with T2DM remains to be discussed.Object1.To determine the correlation between ED and serum FT level in male patients with type 2 diabetes mellitus.2.To explore the influencing factors of erectile dysfunction and serum free testosterone level in male patients with type 2 diabetes mellitus.Method1.From May 2018 to February 2019,110 male patients with type 2 diabetes mellitus admitted to the Department of Endocrinology of the first affiliated Hospital of Zhengzhou University were collected.Their general information,history data,laboratory indexes and the results of the International erectile function Index?IIEF-5?questionnaire were collected.According to the results of the IIEF-5questionnaire.2.The subjects were divided into the ED group?erectile dysfunction group,total score of IIEF-5?21 scores,51 cases?and the NED group?no erectile dysfunction group,total score of IIEF-5?22 points,59 cases?,and the difference of the data between the groups was compared.A multi-factor logistic regression analysis was performed with the presence or absence of ED as the dependent variable and the resulting statistically significant factors as the independent variables.3.According to the ternary digit of FT,the subjects were divided into three groups:F1 group?FT?9.15 pg/ml,37 cases?,F2 group?9.15?11.51 pg/ml,37 cases?and F3 group?FT?11.51 pg/ml,36 cases?.The differences among groups were compared.4.234 male patients with type 2 diabetes mellitus who had not completed the IIEF-5 questionnaire were collected.All 344 patients were divided into Q1 group?FT?8.21 pg/ml,115 cases?,Q2 group?8.21<FT<11.05 pg/ml,114 cases?,and Q3??11.05 pg/ml,115 cases?,according to the serum FT level.The clinical data of the subjects were compared among the groups.Logistic regression analysis was used to explore the influencing factors of serum FT.Result1.Of the 110 patients who completed the questionnaire,51?46.4%?were in ED group?mean age 49.39 years?and 59?53.6%?in NED group?mean age 42.58 years?.The age of the ED group was older than that of the NED group,and there was significant difference between the two groups?P<0 05?.2.There was no significant difference in the family history of diabetes,current smoking rate,current drinking rate,prevalence of hypertension,prevalence of hyperlipidemia and the application rate of metformin,CCB,statins,ACEI/ARB,?receptor antagonists,insulin in ED and NED group?P>0.05?.3.There was no significant difference in the prevalence of diabetic nephropathy and diabetic neuropathy between ED group and NED group?P>0 05?.The prevalence rates of diabetic retinopathy and diabetic macroangiopathy were 43.1%and 74.5%?P<0.05?.It was significantly higher than that in NED group?15.3%,55.9%?.4.The prevalence rate of insulin resistance was 73.3%in ED group and 90.0%in NED group.There was no significant difference in the prevalence of TSH,LH,TT,DHT,DHEAS,AD,HbA1c,FBG,FINS,HOMA-IR and insulin resistance between ED group and NED group.5.The levels of FT,FT₃ and FT₄ in ED group were lower than those in NED group,while the levels of FSH and SHBG in NED group were higher than those in NED group.There was significant difference between groups?P<0.05?.6.Multivariate logistic regression analysis showed that after adjusting for age,course of diabetes mellitus,BMI,HbA1c and blood lipid,low FT,high TSH and diabetic retinopathy are independent risk factors for ED.7.Q1 group?49.08±9.26 years old?was older than Q3 group?43.28±10.57 years old?.TT in Q1 group?2.14?1.91,3.48?ng/ml?was significantly lower than that in Q3group?3.96?3.08,5.07?ng/ml?.There was no significant difference in other data among three groups?P>0.05?.8.All 344 subjects,aged from 18 to 78 years old,with a median age of 50.0 years.Q1a group?54.40±10.17 years old?was older than Q2a group?48.38±11.23 years old?and Q3a group?46.34±11.41 years old?.The course of diabetes mellitus in Q1a group?7.00?3.00,14.00?years?was longer than that in Q3a group?5.00?1.00,10.00?years?.There was significant difference between the two groups?P<0.05?.With the increase of FT,TC and LDL-C increased,HDL-C and FT₄ decreased,and the application rate of statins decreased,but there was no significant difference?P>0.05?.The level of TG in Q1a group was lower than that in Q2a and Q3a groups,and the level of FT₃ in Q1a group was lower than that in Q3a group.The difference was significant?P<0.05?.9.Logistic regression analysis showed that after adjusting for age,after BMI,HbA1c,with the increase of the course of diabetes mellitus for 1 year,the OR value of FT decreased 1.146 times as much as that of the original?95%CI1.027-1.279,P<0.05?.And with the increase of 1 ng/l in TT,the OR value of FT decreased to 0.541 times as much as that of the original?95%CI 0.367-0.796,P<0.05?.Conclusion1.The risk of ED in men with type 2 diabetes mellitus was increased with low serum FT and the occurrence of diabetic retinopathy.2.The risk of serum FT decrease in male patients with type 2 diabetes increases with the prolongation of the course of diabetes.