BARCELONA – If a man with type 1 diabetes develops erectile dysfunction, the first appearance spontaneously resolves more than half the time, according to data collected from nearly 700 men followed for 16 years.

But of those men whose first erectile dysfunction (ED) episode resolves, more than half will experience a recurrence. Furthermore, although these recurrences may resolve as well, the likelihood of resolution falls over time, and the chance of resolution also drops as repeated cycles of ED and resolution accumulate, Dr. Hunter Wessells said at the annual meeting of the European Association for the Study of Diabetes.

Factors affecting this pattern of ED onset and resolution appear to include modifiable risks such as glycemic control, blood pressure, and body mass index, and a "point of no return" for ED resolution "may be postulated based on patient’s age, level of hemoglobin A_1c, and duration of ED," said Dr. Wessells, professor and chairman of urology at the University of Washington in Seattle.

The findings suggest that a window of opportunity exists when ED first appears to boost the chance of resolution through improved glycemic control and other interventions.

"I counsel men with type 1 diabetes and new-onset ED that with increased exercise, better blood pressure control, weight loss, and better glycemic control they have a good chance of reversing their ED," Dr. Wessells said in an interview. "It’s an opportunity to intervene. We don’t yet have firm evidence for this, but as a clinician I give this advice. We need to run a clinical trial to show whether, for example, lowering HbA_1c can reverse ED. If you have a man with ED and an HbA_1c of 10%, if you bring him down to 7% I think you could probably reverse his ED, but currently that is just my speculation."

Dr. Wessells and his associates used data collected from men during the Diabetes Control and Complications Trial (DCCT) – which enrolled 1,441 men and women with type 1 diabetes starting in 1983 at 29 centers in the United States and Canada – and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, which extended the follow-up of more than 90% of the originally-enrolled patients.

Their new analysis focused on 683 men who were followed for 16 years; their average age at their most recent follow-up was 50 years. During follow-up, the men completed an annual survey, which included a question that asked whether or not they had impotence, and a second question of whether or not they were using a drug for ED. Men who answered yes to either question were considered to have ED.

In this cohort, 326 men (48%) never developed ED, 77 (11%) had a single episode during follow-up that later resolved, 158 (23%) had two or more episodes of ED occurrences followed by resolution, and 122 men (18%) developed ED and never had resolution. By the end of the 16 years of follow-up, the majority of men who had multiple episodes of ED onset and resolution had progressed to unremitting ED.

The results showed that among the 357 men in this cohort who developed ED, 235 (66%) had resolution of their first episode.

To explore potential correlates of ED onset and resolution, they further analyzed the subgroup of 333 men from this group with at least 7 years of completed information on their ED status (although all men were followed for 16 years, many had years when they did not supply survey information). The researchers found that, on average, the men whose ED resolved were slightly younger than those whose ED did not resolve, and they had a lower BMI. In addition, men with a single ED episode had an average HbA_1c of 8.1%, compared with 8.4% among those with multiple episodes of ED and resolution, and an average 8.8% level in men whose ED never resolved. The prevalence of an HbA_1c level of 8% or higher was 47% in men with a single, transient episode, 66% in those with multiple transient episodes, and 71% among men whose ED never resolved.

The results also showed that when ED persisted for more than a year, the chance of subsequent resolution fell with time. Men with 2 consecutive years of reporting ED had a 50% rate of resolution the next year. The resolution rate continued to fall as the duration of ED increased, and when men had 5 consecutive years reporting ED, 25% had resolution the following year. "By the fifth year, ED status was essentially set," Dr. Wessells said.

Dr. Wessells said that he had no disclosures. The DCCT and EDIC trials were sponsored by the National Institutes of Health

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

ED in type 1 diabetes often resolves