Recent Advances in Male Type 2 Diabetics with Erectile Dysfunction

doi:10.12114/j.issn.1007-9572.2020.00.499

Abstract

Abstract: Erectile dysfunction is a microvascular complication of type 2 diabetes，a common chronic disease with global prevalence，but is often neglected.Erectile dysfunction prevalence is increasing，which seriously affects life quality，marital stability and family harmony of the patients.We reviewed the epidemiology，risk factors，pathogenesis，and treatment of erectile dysfunction in type 2 diabetics，aiming to improve the public awareness of this disease，and enhance the life quality of these patients by providing them with theoretical treatment guidance.

Key words: Diabetes mellitus, type 2；Erectile dysfunction；Risk factors；Pathogenesis；Therapy

摘要： 糖尿病是全球常见慢性病之一，而勃起功能障碍作为经常被忽视的2型糖尿病微血管并发症之一，其患病率呈上升趋势，严重影响患者生活质量、婚姻稳定及家庭和谐。现将从2型糖尿病伴勃起功能障碍的流行病学、危险因素、发病机制及治疗等方面进行综述，旨在提高全民对2型糖尿病伴勃起功能障碍的认识，为2型糖尿病伴勃起功能障碍患者的治疗提供理论指导，从而提高患者生活质量。

关键词: 糖尿病, 2型；勃起功能障碍；危险因素；发病机制；治疗

NIE Li,LI Yanhua,LI Junwei. Recent Advances in Male Type 2 Diabetics with Erectile Dysfunction　[J]. Chinese General Practice, 2020, 23(33): 4267-4273. DOI: 10.12114/j.issn.1007-9572.2020.00.499.
聂莉,李琰华,李俊伟. 2型糖尿病伴勃起功能障碍的研究进展[J]. 中国全科医学, 2020, 23(33): 4267-4273. DOI: 10.12114/j.issn.1007-9572.2020.00.499.

References

［1］CHEN L，MAGLIANO D J，ZIMMET P Z.The worldwide epidemiology of type 2 diabetes mellitus——present and future perspectives［J］．Nat Rev Endocrinol，2011，8（4）：228-236．DOI：10.1038/nrendo.2011.183.
［2］OGURTSOVA K，DA ROCHA FERNANDES J D，HUANG Y，et al．IDF Diabetes Atlas：Global estimates for the prevalence of diabetes for 2015 and 2040［J］．Diabetes Res Clin Pract，2017，128：40-50．DOI：10.1016/j.diabres.2017.03.024.
［3］ZIMMET P，ALBERTI K G，MAGLIANO D J，et al．Diabetes mellitus statistics on prevalence and mortality：facts and fallacies［J］．Nat Rev Endocrinol，2016，12（10）：616-622．DOI：10.1038/nrendo.2016.105.
［4］中华医学会糖尿病学分会.中国2型糖尿病防治指南（2017年版）［J］．中华糖尿病杂志，2018，10（1）：4-67.
［5］ZHANG X Y，YANG B，LI N，et al．Prevalence and risk factors for erectile dysfunction in Chinese adult males［J］．J Sex Med，2017，14（10）：1201-1208．DOI：10.1016/j.jsxm.2017.08.009.
［6］SELVIN E，BURNETT A L，PLATZ E A.Prevalence and risk factors for erectile dysfunction in the US［J］．Am J Med，2007，120（2）：151-157．DOI：10.1016/j.amjmed.2006.06.010.
［7］FASELIS C，KATSIMARDOU A，IMPRIALOS K，et al．Microvascular complications of type 2 diabetes mellitus［J］．Curr Vasc Pharmacol，2020，18（2）：117-124．DOI：10.2174/1570161117666190502103733.
［8］MALAVIGE L S，LEVY J C.Erectile dysfunction in diabetes mellitus［J］．J Sex Med，2009，6（5）：1232-1247．DOI：10.1111/j.1743-6109.2008.01168.x.
［9］AYTA I A，MCKINLAY J B，KRANE R J.The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences［J］．BJU Int，1999，84（1）：50-56．DOI：10.1046/j.1464-410x.1999.00142.x.
［10］KOUIDRAT Y，PIZZOL D，COSCO T，et al．High prevalence of erectile dysfunction in diabetes：a systematic review and meta-analysis of 145 studies［J］．Diabet Med，2017，34（9）：1185-1192．DOI：10.1111/dme.13403.
［11］GIUGLIANO F，MAIORINO M，BELLASTELLA G，et al．Determinants of erectile dysfunction in type 2 diabetes［J］．Int J Impot Res，2010，22（3）：204-209．DOI：10.1038/ijir.2010.1.
［12］ASSOCIATION A D.Diagnosis and classification of diabetes mellitus［J］．Diabetes Care，2013，36（Supplement_1）：S67-74．DOI：10.2337/dc13-s067.
［13］XU Y W，ZHANG Y Y，YANG Y J，et al．Prevalence and correlates of erectile dysfunction in type 2 diabetic men：a population-based cross-sectional study in Chinese men［J］．Int J Impot Res，2019，31（1）：9-14．DOI：10.1038/s41443-018-0060-4.
［14］UGWUMBA F O，OKAFOR C I，NNABUGWU I I，et al．Prevalence of，and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu，South East Nigeria［J］．Ann Afr Med，2018，17（4）：215-220．DOI：10.4103/aam.aam_3_18.
［15］HATZIMOURATIDIS K，HATZICHRISTOU D.How to treat erectile dysfunction in men with diabetes：from pathophysiology to treatment［J］．Curr Diab Rep，2014，14（11）：545．DOI：10.1007/s11892-014-0545-6.
［16］NIKOLAIDOU B，NOURIS C，LAZARIDIS A，et al．Diabetes mellitus and erectile dysfunction［M］//Erectile dysfunction in hypertension and cardiovascular disease.Cham：Springer International Publishing，2014：119-128．
［17］ELBENDARY M A，EL-GAMAL O M，SALEM K A.Analysis of risk factors for organic erectile dysfunction in Egyptian patients under the age of 40 years［J］．J Androl，2009，30（5）：520-524．DOI：10.2164/jandrol.108.007195.
［18］张高芝，黄晓燕，董海平，等．中青年2型糖尿病患者中勃起功能障碍及相关危险因素调查分析［J］．实用预防医学，2015，22（10）：1230-1231，1217.
［19］AZAD A K，SETUNGE S，SELIM S，et al．Dyslipidaemia as a risk factor for erectile dysfunction in type 2 diabetes mellitus patients［J］．Diabetes Metab Syndr，2019，13（1）：748-753．DOI：10.1016/j.dsx.2018.11.052.
［20］NISAHAN B，KUMANAN T，RAJESHKANNAN N，et al．Erectile dysfunction and associated factors among men with diabetes mellitus from a tertiary diabetic center in Northern Sri Lanka［J］．BMC Res Notes，2019，12（1）：210．DOI：10.1186/s13104-019-4244-x.
［21］ERDEN S，KAYA H.Sexual dysfunction and anxiety levels of type 2 male diabetics［J］．Appl Nurs Res，2015，28（3）：239-243．DOI：10.1016/j.apnr.2015.04.014.
［22］SEFTEL A D.Re：testosterone therapy for sexual dysfunction in men with type 2 diabetes：a systematic review and meta-analysis of randomized controlled trials［J］．J Urol，2018，199（5）：1096．DOI：10.1016/j.juro.2018.02.057.
［23］KIRILMAZ U，GUZEL O，ASLAN Y，et al．The effect of lifestyle modification and glycemic control on the efficiency of sildenafil citrate in patients with erectile dysfunction due to type-2 diabetes mellitus［J］．Aging Male，2015，18（4）：244-248．DOI：10.3109/13685538.2015.1072154.
［24］GRATZKE C，ANGULO J，CHITALEY K，et al．Anatomy，physiology，and pathophysiology of erectile dysfunction［J］．J Sex Med，2010，7（1 Pt 2）：445-475．DOI：10.1111/j.1743-6109.2009.01624.x.
［25］蒋波.勃起功能障碍与血管内皮因子的相关性研究进展［J］．现代中西医结合杂志，2017，26（6）：679-682.
［26］TRZASKOWSKI B，LATEK D，YUAN S，et al．Action of molecular switches in GPCRs——theoretical and experimental studies［J］．Curr Med Chem，2012，19（8）：1090-1109．DOI：10.2174/092986712799320556.
［27］CARETTA N，DE KREUTZENBERG S V，VALENTE U，et al．Hypovitaminosis D is associated with erectile dysfunction in type 2 diabetes［J］．Endocrine，2016，53（3）：831-838．DOI：10.1007/s12020-015-0851-z.
［28］PASTUSZAK A W.Current diagnosis and management of erectile dysfunction［J］．Curr Sex Health Rep，2014，6（3）：164-176．DOI：10.1007/s11930-014-0023-9.
［29］BIVALACQUA T J，USTA M F，CHAMPION H C，et al．Endothelial dysfunction in erectile dysfunction：role of the endothelium in erectile physiology and disease［J］．J Androl，2003，24（6 Suppl）：S17-37．DOI：10.1002/j.1939-4640.2003.tb02743.x.
［30］MUSICKI B，HANNAN J L，LAGODA G，et al．Mechanistic link between erectile dysfunction and systemic endothelial dysfunction in type 2 diabetic rats［J］．Andrology，2016，4（5）：977-983．DOI：10.1111/andr.12218.
［31］HACKETT G，KRYCHMAN M，BALDWIN D，et al．Coronary heart disease，diabetes，and sexuality in men［J］．J Sex Med，2016，13（6）：887-904．DOI：10.1016/j.jsxm.2016.01.023.
［32］PERNOW J，JUNG C.The emerging role of arginase in endothelial dysfunction in diabetes［J］．Curr Vasc Pharmacol，2016，14（2）：155-162．DOI：10.2174/1570161114666151202205617.
［33］SINGH R，BARDEN A，MORI T，et al．Advanced glycation end-products：a review［J］．Diabetologia，2001，44（2）：129-146．DOI：10.1007/s001250051591.
［34］CARTLEDGE J J，EARDLEY I，MORRISON J F.Nitric oxide-mediated corpus cavernosal smooth muscle relaxation is impaired in ageing and diabetes［J］．BJU Int，2001，87（4）：394-401．DOI：10.1046/j.1464-410x.2001.00065.x.
［35］SULLIVAN M E，DASHWOOD M R，THOMPSON C S，et al．Alterations in endothelin B receptor sites in cavernosal tissue of diabetic rabbits：potential relevance to the pathogenesis of erectile dysfunction［J］．J Urol，1997，158（5）：1966-1972．DOI：10.1016/s0022-5347（01）64195-8.
［36］TAKAHASHI K，GHATEI M A，LAM H C，et al．Elevated plasma endothelin in patients with diabetes mellitus［J］．Diabetologia，1990，33（5）：306-310．DOI：10.1007/BF00403325.
［37］MISHRA R K，ALOKAM R，SRIRAM D，et al．Potential role of Rho kinase inhibitors in combating diabetes-related complications including diabetic neuropathy——a review［J］．Curr Diabetes Rev，2013，9（3）：249-266．DOI：10.2174/1573399811309030006.
［38］SANDIREDDY R，YERRA V G，ARETI A，et al．Neuroinflammation and oxidative stress in diabetic neuropathy：futuristic strategies based on these targets［J］．Int J Endocrinol，2014，2014：674987．DOI：10.1155/2014/674987.
［39］GUR S，PEAK T C，KADOWITZ P J，et al．Review of erectile dysfunction in diabetic animal models［J］．Curr Diabetes Rev，2014，10（1）：61-73．DOI：10.2174/1573399809666131126151024.
［40］KIZUB I V，KLYMENKO K I，SOLOVIEV A I.Protein kinase C in enhanced vascular tone in diabetes mellitus［J］．Int J Cardiol，2014，174（2）：230-242．DOI：10.1016/j.ijcard.2014.04.117.
［41］MAIORINO M I，BELLASTELLA G，ESPOSITO K.Diabetes and sexual dysfunction：current perspectives［J］．Diabetes Metab Syndr Obes，2014，7：95-105．DOI：10.2147/DMSO.S36455.
［42］HACKETT G，COLE N，SAGHIR A，et al．Testosterone undecanoate improves sexual function in men with type 2 diabetes and severe hypogonadism：results from a 30-week randomized placebo-controlled study［J］．BJU Int，2016，118（5）：804-813．DOI：10.1111/bju.13516.
［43］KELLY D M，JONES T H.Testosterone：a metabolic hormone in health and disease［J］．J Endocrinol，2013，217（3）：R25-45．DOI：10.1530/JOE-12-0455.
［44］CARETTA N，DE KREUTZENBERG S V，VALENTE U，et al．Hypovitaminosis D is associated with erectile dysfunction in type 2 diabetes［J］．Endocrine，2016，53（3）：831-838．DOI：10.1007/s12020-015-0851-z.
［45］BIRD I M.Endothelial nitric oxide synthase activation and nitric oxide function：new light through old windows［J］．J Endocrinol，2011，210（3）：239-241．DOI：10.1530/JOE-11-0216.
［46］THOMA C.Erectile dysfunction：Vardenafil in men with T2DM［J］．Nat Rev Urol，2016，13（3）：126．DOI：10.1038/nrurol.2016.30.
［47］林向楠，石磊，高振利，等．糖尿病性勃起功能障碍中血管因素发病机制的研究［J］．中国男科学杂志，2016，30（10）：66-69.
［48］周斌，谢高宇，齐敏友.糖尿病性勃起障碍发病机制及治疗研究进展［J］．中国药理学与毒理学杂志，2015，29（4）：626-632.
ZHOU B，XIE G Y，QI M Y.Advances in pathogenesis and medication of diabetes-induced erectile dysfunction［J］．Chinese Journal of Pharmacology and Toxicology，2015，29（4）：626-632.
［49］CHEN S，PENG D，XU X，et al．Assessment of erectile dysfunction and associated psychological distress in Chinese men with type 2 diabetes mellitus［J］．Int J Impot Res，2017，29（5）：210-214．DOI：10.1038/ijir.2017.25.
［50］DEROSA G，ROMANO D，TINELLI C，et al．Prevalence and associations of erectile dysfunction in a sample of Italian males with type 2 diabetes［J］．Diabetes Res Clin Pract，2015，108（2）：329-335．DOI：10.1016/j.diabres.2015.01.037.
［51］BEN KHEDHER M R，BOUHAJJA H，HAJ AHMED S，et al．Role of disturbed fatty acids metabolism in the pathophysiology of diabetic erectile dysfunction［J］．Lipids Health Dis，2017，16（1）：241．DOI：10.1186/s12944-017-0637-9.
［52］李赛花，黄萍.心理干预对糖尿病勃起功能障碍患者心理状态的影响［J］．大众科技，2013，15（7）：123-124，126.
LI S H，HUANG P.Effect of psychological intervention on mental state of patients with diabetic erectile dysfunction［J］．Popular Science & Technology，2013，15（7）：123-124，126.
［53］KAMENOV Z.A comprehensive review of erectile dysfunction in men with diabetes［J］．Exp Clin Endocrinol Diabetes，2014，123（3）：141-158．DOI：10.1055/s-0034-1394383.
［54］HAMIDI MADANI A，ASADOLAHZADE A，MOKHTARI G，et al．Assessment of the efficacy of combination therapy with folic acid and tadalafil for the management of erectile dysfunction in men with type 2 diabetes mellitus［J］．J Sex Med，2013，10（4）：1146-1150．DOI：10.1111/jsm.12047.
［55］RYU J K，SUH J K，BURNETT A L.Research in pharmacotherapy for erectile dysfunction［J］．Transl Androl Urol，2017，6（2）：207-215．DOI：10.21037/tau.2016.11.17.
［56］PHé V，ROUPRêT M.Erectile dysfunction and diabetes：a review of the current evidence-based medicine and a synthesis of the main available therapies［J］．Diabetes Metab，2012，38（1）：1-13．DOI：10.1016/j.diabet.2011.09.003.
［57］MYDLO J H，VOLPE M A，MACCHIA R J.Initial results utilizing combination therapy for patients with a suboptimal response to either alprostadil or sildenafil monotherapy［J］．Eur Urol，2000，38（1）：30-34．DOI：10.1159/000020248.
［58］MEULEMAN E J.Experiences with a vacuum apparatus in the treatment of erection disorders［J］．Ned Tijdschr Geneeskd，1993，137（8）：412-416.
［59］SEFTEL A D.Re：testosterone therapy for sexual dysfunction in men with type 2 diabetes：a systematic review and meta-analysis of randomized controlled trials［J］．J Urol，2018，199（5）：1096．DOI：10.1016/j.juro.2018.02.057.
［60］BETTOCCHI C，PALUMBO F，SPILOTROS M，et al．Patient and partner satisfaction after AMS inflatable penile prosthesis implant［J］．J Sex Med，2010，7（1 Pt 1）：304-309．DOI：10.1111/j.1743-6109.2009.01499.x.
［61］WILSON S K，ZUMBE J，HENRY G D，et al．Infection reduction using antibiotic-coated inflatable penile prosthesis［J］．Urology，2007，70（2）：337-340．DOI：10.1016/j.urology.2007.03.058.
［62］QIU X F，LIN G T，XIN Z C，et al．Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model［J］．J Sex Med，2013，10（3）：738-746．DOI：10.1111/jsm.12024.
［63］KHO H G，SWEEP C G，CHEN X，et al．The use of acupuncture in the treatment of erectile dysfunction［J］．Int J Impot Res，1999，11（1）：41-46．DOI：10.1038/sj.ijir.3900381.
［64］尹昀东，方朝晖.糖尿病性勃起功能障碍中医药研究进展［J］．中医药临床杂志，2019，31（11）：2027-2030．DOI：10.16448/j.cjtcm.2019.0589.
YIN Y D，FANG C H.Research progress of traditional Chinese medicine on diabetic erectile dysfunction［J］．Clinical Journal of Traditional Chinese Medicine，2019，31（11）：2027-2030．DOI：10.16448/j.cjtcm.2019.0589.
［65］商建伟，穆俊，盛文，等．填精通络方及其拆方对糖尿病性勃起功能障碍大鼠性激素及性功能的影响［J］．世界中西医结合杂志，2019，14（7）：937-940，977．DOI：10.13935/j.cnki.sjzx.190713.
SHANG J W，MU J，SHENG W，et al．Effect of tianjing tongluo formula and its herbal compositions on sexual hormone and function in the rats with diabetic erectile dysfunction［J］．World Journal of Integrated Traditional and Western Medicine，2019，14（7）：937-940，977．DOI：10.13935/j.cnki.sjzx.190713.
［66］商建伟，盛文，李宪锐，等．填精通络方及其拆方对糖尿病性勃起功能障碍大鼠的性激素及阴茎海绵体eNOS酶表达的影响［J］．世界科学技术-中医药现代化，2019，21（3）：547-552．DOI：10.11842/wst.2019.03.034.
SHANG J W，SHENG W，LI X R，et al．Effects of Tianjing Tongluo decoction and its disassembled formulae on sex hormones and the expression of penile cavernosa eNOS enzyme in diabetic rats with erectile dysfunction［J］．World Science and Technology-Modernization of Traditional Chinese Medicine，2019，21（3）：547-552．DOI：10.11842/wst.2019.03.034.
［67］刘平，孙树本，王建强，等．疏肝益阳胶囊联合西地那非治疗糖尿病性勃起功能障碍效果观察［J］．中国乡村医药，2018，25（12）：41-42．DOI：10.3969/j.issn.1006-5180.2018.12.023.

[1]	ZHANG Yunuo, LI Ruibin, WANG Wei. Correlation Analysis of Serum Nesfatin-1 and Ghrelin Levels with Glycolipid Metabolism and Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2025, 28(26): 3264-3270.
[2]	ZHANG Ruimin, DONG Zheyi, LI Shuang, WANG Qian, CHEN Xiangmei. Traditional Chinese Medicine Factors Associated with Diabetic Nephropathy Diagnosed by Renal Biopsy [J]. Chinese General Practice, 2025, 28(26): 3307-3313.
[3]	TANG Shangfeng, HUANG Yangzhen, ZHENG Yanxi, PAN Yangyang, XIONG Zhongbao, QING Hua, SONG Jia, WEI Yilin, DONG Heng, WANG Chunying, CHEN Manwei, ZHANG Kangkang. Specification for the Integration of Healthcare and Prevention Services in Diabetes at the Primary Level [J]. Chinese General Practice, 2025, 28(25): 3096-3103.
[4]	YANG Chen, CHEN Tong, ZHANG Lifang, ZHANG Hongxu, LI Pengfei, ZHANG Xuejuan. Prognostic Impact of Dapagliflozin in Elderly Breast Cancer Survivors with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes [J]. Chinese General Practice, 2025, 28(24): 3053-3058.
[5]	WANG Rupeng, NAN Jing, HU Yiran, YANG Shenghua, JIN Zening. Predictive Value of the Triglyceride-Glucose Body Mass Index for Slow Flow/No-reflow Phenomenon in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention [J]. Chinese General Practice, 2025, 28(24): 2985-2992.
[6]	LIU Yueying, WANG Xueli, LIU Yuqiu, WEI Limin. Correlation of Fasting C-peptide to Diabetes Duration Ration and Type 2 Diabetes Mellitus Combined with Metabolism-related Fatty Liver Disease [J]. Chinese General Practice, 2025, 28(23): 2852-2860.
[7]	WANG Peng, QIU Lixia, XU Shanshan, ZHANG Yang, ZHANG Jing, DU Xiaofei. Advances in the Co-management of Metabolism Dysfunction-associated Fatty Liver Disease and Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2025, 28(23): 2846-2851.
[8]	BAI Xue, CHEN Qianqian, LI Jie. Innovative Practices in Chronic Disease Management: a New Model for Generalist-Specialist Combination Management of Diabetes and Metabolic Dysfunction-associated Fatty Liver Disease [J]. Chinese General Practice, 2025, 28(23): 2841-2845.
[9]	TANG Xiaorui, XU Jingjing, GU Zijun, WANG Qingyu, LIN Zheng, ZHU Qiurui, LEI Yang. The Reliability and Validity of the Chinese Version of Self-Care of Diabetes Inventory [J]. Chinese General Practice, 2025, 28(21): 2643-2651.
[10]	WANG Ying, YAN Yijun, LIU Lei, HU Yumin, ZHANG Yang, LIU Kai, JIANG Boren. Effects of Resistance Exercise Combined with Nutritional Intervention on Blood Glucose Stability in Elderly Patients with Type 2 Diabetes Mellitus with Sarcopenia [J]. Chinese General Practice, 2025, 28(21): 2604-2610.
[11]	MA Panpan, WANG Sijing, YOU Na, DING Dafa, LU Yibing. Efficacy and Safety of Danuglipron and Orforglipron in the Treatment of Type 2 Diabetes Mellitus: a Meta-analysis [J]. Chinese General Practice, 2025, 28(21): 2679-2685.
[12]	JIN Yan, YANG Yang, WANG Lulu, ZHENG Qingwan, LI Xinyan, ZHANG Ning. Effects of Exercise Training after Bariatric Surgery on Cardiopulmonary Function in Patients with Type 2 Diabetes Mellitus and Obesity: a Randomized Controlled Trial [J]. Chinese General Practice, 2025, 28(21): 2611-2617.
[13]	FU Rong, SHI Lei, HE Feiying. Comorbidity of Diabetes and Depression in Middle-aged and Elderly People: the Impact of Sleep, Exercise, and Social Activities [J]. Chinese General Practice, 2025, 28(20): 2491-2500.
[14]	HUANG Zhijie, MAI Zhihua, WANG Haoxiang, HE Yuming, DENG Qiaoyan, DAI Ranran, ZHOU Zhiheng. Multimorbidity of Hypertension, Diabetes, and Dyslipidemia and Influencing Factors of Family Function among the Elderly [J]. Chinese General Practice, 2025, 28(16): 2001-2010.
[15]	ZHAO Xiaoxiao, KE Lixin, XUN Yangqin, WANG Haibo, GAO Wulin, QIAO Tianci, LU Xiaohui, WU Jibiao, LU Cuncun. Investigation and Future Trend Prediction of Disease Burden of Elderly Type 2 Diabetes Mellitus Globally and in China from 1990 to 2021 [J]. Chinese General Practice, 2025, 28(16): 2050-2058.