Prevalence of erectile dysfunction and associated risk factors among diabetic men attending diabetic clinic at Muhimbili national hospital in Dar-es-salaam, Tanzania.

Abstract

Introduction: There has been an increase in the prevalence of erectile dysfunction (ED) in the general population. This increase has been attributed to by several factors. Among these factors Diabetes Mellitus have been shown to be a major determinant. Objective: To determine the prevalence of erectile dysfunction and associated risk factors among diabetic men attending diabetic clinic at Muhimbili National Hospital (MNH). Methodology: This was a prospective cross-sectional hospital based study, was conducted among 312 consecutively recruited diabetic male patients (Mean age = 51.33 years, SD = 15.03 years) for the period of 8 months from May to December 2011. Data were collected using a structured questionnaire, which consisted of several demographic variables, clinical aspects variables and International Index of Erectile Function (IIEF) questionnaire. Descriptive statistics were calculated to describe the study population and check for initial associations at univariate level. Multivariate logistic regression was used to identify and quantify predictors of ED among these men. Variables that were entered in the equation were duration of diabetes mellitus (DM), type of DM, history of smoking, history of alcohol, history of stroke, history of peripheral neuropathy, monofilament score, being hypertensive, lipid profile, fasting blood sugar, level of Glycosylated hemoglobin (HbA1c) and Ankle Brachial Index (ABI) score while controlling for other demographics. Results: The prevalence of erectile dysfunction was found to be 55.1% (n= 172). Forty patients (12.8%) had mild dysfunction, 45 (11.5%) had moderate dysfunction, and 87 (27.9%) had severe dysfunction. The prevalence was higher (78%) in men aged 60 years and above (p < 0.001); there is a trend towards increase in prevalence of erectile dysfunction as the age increases. Longer duration of DM, type 2 DM, history of peripheral neuropathy, history of hypertension, low score on monofilament test, and evidence of peripheral vascular disease were highly significantly associated with ED (p =<0.001). History of smoking, history of drinking alcohol, and history of stroke were also significantly associated ED (P = 0.02, 0.05, and 0.01 respectively). On multivariate logistic regression the predictors of ED were found to be old age (odds ratio [OR] ix = 7.1, 95% CI 1.2-40.7), evidence of peripheral neuropathy ([OR] =5.9, 95% CI 1.6-21.3), and evidence of peripheral vascular disease ([OR] =2.5, 95% CI 1.2-5.3) {p= 0.028, 0.019, and 0.007 respectively}. This study also showed that ED was highly statistically significant associated with other sexual domains (p <0.001). Conclusions and Recommendations: This study showed that the prevalence of erectile dysfunction is high among DM patients. Interventions aimed at prevention of DM especially type 2; early diagnosis of DM and detection of its complications, and adherence to treatment to prevent complication should be implemented. Further studies should emphasize on temporal variation to show true causality of DM on erectile dysfunction especially in low-income settings.