(127) Prevalence of Erectile Dysfunction in Men with Diabetes: A Systematic Review

Introduction • Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is a significant male health problem, with global projections of up to 322 million men affected in coming years. • Diabetes mellitus (DM) is a major risk factor for ED. Men with diabetes develop ED more frequently and at younger ages than non-diabetic men. Chronic hyperglycemia leads to endothelial dysfunction, oxidative stress, advanced glycation end-product formation, and neuropathy, all of which impair normal erectile function. Objective • ED in diabetic men is not only physically impactful but also diminishes quality of life and self-esteem, and it may serve as an early warning sign of silent cardiovascular disease. Given this clinical significance, international health organizations (ISSM, WHO, AUA, etc.) have highlighted the importance of understanding the true burden of ED in diabetes to inform screening and management strategies. Methods • Design: Systematic review conducted according to PRISMA guidelines. The protocol included predefined eligibility criteria and a comprehensive literature search. • Data Sources: Searched multiple databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library, Google Scholar) for studies published 2019–2024 reporting ED prevalence in men with type 1 or type 2 diabetes. No language restrictions were applied. • Inclusion Criteria: Original studies (observational studies, systematic reviews, or meta-analyses) in adult diabetic men (≥18 years) that reported prevalence of ED using standardized assessment methods. Studies focusing on special subgroups (e.g. post-prostatectomy only) or not separating diabetic-specific prevalence were excluded. • Study Selection & Data Extraction: Two independent reviewers screened titles/abstracts and full texts, then extracted data from included studies. Disagreements were resolved by consensus. • Outcome Measures: The primary outcome was prevalence of ED (percentage of men with diabetes who have ED). Data on associated factors (age, diabetes duration, comorbidities, etc.) were also extracted. • Quality Assessment: The quality of evidence was appraised (e.g., AMSTAR 2 tool for systematic reviews and Newcastle-Ottawa Scale for observational studies) to ensure reliability. We included high-quality recent evidence, notably large meta-analyses and an umbrella review (2024) that synthesized multiple systematic reviews. In total, the review encompasses data from ~100,000 diabetic men across diverse regions. Results Prevalence of ED in Diabetic Men (Overall): ED is highly prevalent among men with diabetes. Pooled global estimates indicate roughly 2 in 3 men with diabetes (~65%) experience ED. For example, a 2024 umbrella review including ~108,000 diabetic men found a 65.8% overall prevalence of ED (95% CI: 58.3–73.3%). These figures are dramatically higher than in the general male population (where ED prevalence is ~20–30%). In fact, men with diabetes have about a 3–4 fold greater odds of developing ED compared to age-matched non-diabetics. Type 1 vs. Type 2 Diabetes: ED afflicts men with both type 1 and type 2 DM, but rates are higher in type 2. An earlier meta-analysis (2017) reported average ED prevalence of 66.3% in type 2 diabetics versus 37.5% in type 1. More recent data confirm this disparity: a 2024 review focusing on type 1 DM found a combined ED prevalence of 42.5% whereas studies of predominantly type 2 populations report roughly 60–70% or greater. The lower prevalence in type 1 DM may reflect younger age of onset and intensive early management (possibly delaying vascular complications), but it is noteworthy that even ~4 in 10 men with type 1 diabetes have ED – far above rates in non-diabetics of similar age. Conclusions In conclusion, erectile dysfunction is extremely prevalent among men with diabetes, affecting roughly half to two-thirds of this patient population worldwide. Men with diabetes have a significantly higher risk of developing ED than those without diabetes and often experience the onset of ED at earlier ages. Factors such as older age, long duration of diabetes, poor metabolic control (obesity), and vascular complications further elevate this risk. These findings underscore that ED should be recognized as an important and common complication of diabetes, with substantial implications for physical health, mental health, and quality of life. Given this reality, we strongly recommend that healthcare professionals incorporate sexual health evaluation into routine diabetes care. Every male patient with diabetes should be periodically asked about ED symptoms, and if present, offered comprehensive management: optimization of blood glucose and cardiovascular risk factors, lifestyle modifications, and appropriate specific treatments for ED. Early intervention for ED in men with diabetes can not only improve sexual function and satisfaction but also potentially serve as a strategy to identify individuals at heightened cardiovascular risk who may benefit from more intensive prevention efforts. In sum, given the high burden of ED in the diabetic population demonstrated by this review, it is crucial to raise the priority of sexual health in the global diabetes agenda. This means destigmatizing discussions about sexual dysfunction and ensuring that men with diabetes receive the support and treatment needed for a healthy and satisfying sex life. Such efforts will improve not only individual well-being but also couple relationships and could have broader public health benefits by drawing attention to an early marker of cardiovascular disease. Embracing sexual medicine as a component of diabetes care aligns with international standards and will ultimately contribute to better holistic outcomes for patients worldwide. Disclosure No