The efficacy of phosphodiesterase type 5 inhibitors (PDE5i) in patients with erectile dysfunction (ED) and undiagnosed prediabetes (PreDM) has been scantly analysed. We aimed to assess rates of and predictors of response to oral treatment in a cohort of ED men naïve for PDE5i with either normo-glycaemia or PreDM or diabetes mellitus (DM). Complete data from 466 men were analysed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF) at baseline and after 3 months of PDE5i treatment. Treatment response was evaluated using the minimal clinically important difference (MCID) (mild: +2; moderate: +5; severe: +7 from baseline IIEF-EF). PreDM status was defined as for the American Diabetes Association (2015) criteria. Descriptive statistics and logistic regression models tested the association between clinical predictors and MCID response. Overall, 253 (56.7%), 105 (23.5%) and 88 (19.7%) patients had normo-glycaemia (=controls), PreDM and DM, respectively. Diabetic and PreDM men were older, had higher BMI, higher CCI scores and lower total testosterone (tT) (all p < 0.01) compared to controls. Median baseline IIEF-EF was lower both in PreDM (14.0 vs. 18.0; p < 0.05) and DM patients (10.0 vs. 18.0; p < 0.001) than in controls. IIEF-EF improved in all groups after treatment (all p < 0.001), but scores were higher in controls compared to both PreDM and DM men at 3-mos assessment (26.0 vs. 20.0 vs. 17.5, respectively; all p < 0.001). Controls more frequently achieved significant MCID than both PreDM and DM patients (65.3 vs. 22.9 vs. 11.8%, respectively; p < 0.01). Age (p < 0.001), baseline IIEF-EF (p < 0.001), and DM status (p = 0.02) were independently associated with MCID. In conclusion, patients with undiagnosed PreDM depicted lower rates of response to PDE5i than normoglycemic men. These findings suggest that even milder forms of glucose impairment are associated with a poorer PDE5i effectiveness in men with ED.

中文翻译：

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未诊断的糖尿病前期状态与勃起功能障碍男性中5型磷酸二酯酶抑制剂的有效性降低有关。

很少分析了5型磷酸二酯酶抑制剂（PDE5i）在勃起功能障碍（ED）和未确诊的糖尿病前期患者（PreDM）中的疗效。我们的目的是评估未接受PDE5i正常血糖或PreDM或糖尿病（DM）的ED男性队列中口服治疗的发生率和预测指标。分析了来自466名男性的完整数据。用查尔森合并症指数（CCI）对合并症进行评分。患者在基线时和PDE5i治疗3个月后完成了国际勃起功能指数（IIEF）。使用临床上的最小重要差异（MCID）评估治疗反应（轻度：+2；中度：+5；重度：与基线IIEF-EF相比为+7）。根据美国糖尿病协会（2015）的标准定义了PreDM的状态。描述统计和逻辑回归模型测试了临床预测指标与MCID反应之间的关联。总体而言，分别有253名（56.7％），105名（23.5％）和88名（19.7％）的患者患有正常血糖（=对照），PreDM和DM。与对照组相比，糖尿病和PreDM男性年龄更大，BMI更高，CCI得分更高，总睾丸激素（tT）更低（所有p <0.01）。PreDM（14.0 vs. 18.0; p <0.05）和DM患者（10.0 vs. 18.0; p <0.001）的中位基线IIEF-EF均低于对照组。治疗后所有组的IIEF-EF均得到改善（所有p <0.001），但在3个月评估时，与PreDM和DM男性相比，对照组的得分更高（分别为26.0 vs. 20.0 vs. 17.5；所有p <0.001） 。与PreDM和DM患者相比，对照组更经常获得显着的MCID（65.3 vs. 22.9 vs. 11.8％，分别; p <0.01）。年龄（p <0.001），基线IIEF-EF（p <0.001）和DM状态（p = 0.02）与MCID独立相关。总之，未诊断PreDM的患者对PDE5i的反应率低于正常血糖的男性。这些发现表明，即使是较轻度的葡萄糖损害，也与ED患者中较差的PDE5i有效性有关。