Relationship between diabetic retinopathy, diabetic macular oedema and erectile dysfunction in type 2 diabetics

Background: To investigate the relationship of diabetic retinopathy and diabetic macular oedema with erectile dysfunction in patients with type 2 diabetes. Design: Hospital-based, cross-sectional study. Participants: Three hundred twenty-four men with diabetes from the Diabetic Management Project were recruited. Methods: Participants underwent a comprehensive interview, a complete eye examination, fasting blood tests, and had retinal and macula assessments using fundus images and optical coherence tomography, respectively. Diabetic retinopathy was categorized as none, mild, moderate, severe non-proliferative and proliferative, and diabetic macular oedema as none, mild, moderate and severe. Erectile dysfunction was defined as problems achieving or maintaining an erection and was assessed using a self-reported questionnaire. Main Outcome Measures: Erectile dysfunction. Results: The mean±standard deviation age of 324 men with type 2 diabetes was 65.2±11.1 years. Compared with patients without diabetic retinopathy, those with any retinopathy (odds ratio 2.06, 95% confidence interval 1.22-3.48, P=0.007) had a twofold increased odds of having erectile dysfunction. Patients with severe non-proliferative diabetic retinopathy (odds ratio 4.39, 95% confidence interval 1.48-13.0, P=0.008) and proliferative diabetic retinopathy (odds ratio 2.74, 95% confidence interval 1.44-5.19, P=0.002) had fourfold and threefold increased odds of having erectile dysfunction, respectively, compared with those without diabetic retinopathy. Diabetic macular oedema, irrespective of presence or severity, was not independently associated with erectile dysfunction. Conclusion: The presence and severity of diabetic retinopathy but not diabetic macular oedema are independently associated with self-reported erectile dysfunction.