Tejal Gandhi and Anjali Patel conducted manuscript editing and reviewing.
Next, the investigation demonstrates that the prevalence of ED using the IIEF is (more than 50%) higher in men with DM as observed from the HbA1c results. Among 216 participants with sexual dysfunction enrolled in this study, 136 (62.9%) had a higher HbA1c level (7.6–16%). Higher HbA1c levels are associated with ED which was also observed in another study. [25] In addition, testosterone hormone is responsible for normal sexual functioning such as erection and for sexual desire or libido. Among all study participants, 61.9% were found to have a low level of testosterone.
Furthermore, the effect of hypogonadism on reduced libido and DM is supported by several studies. [27,28] Besides, conditions such as metabolic syndrome and atherogenic dyslipidemia are also associated with ED among diabetic men. [29] Among the study participants, 57.8% had high triglyceride levels and 25.4% of subjects had low levels of HDL. This study also presents noteworthy findings when the participants were subjected to Tadalafil or the combination of Tadalafil + Dapoxetine. There was no indication of superiority of either. Literature search and clinical data collection was done by Hiren Raninga. Dr.
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Amol Chaudhari and Dr.
The findings of this study also outline the pressing need of careful examination of sexual dysfunction in healthcare clinics for diabetic individuals. Increased awareness through routine screening for ED can contribute to the timely diagnosis and effective treatment of ED especially in elderly population. The authors of this study do not have any conflicts of interest with publication of the manuscript or an institution or product that is mentioned in the manuscript and/or is important to the outcome of the study presented. Dr. Amol Chaudhari is also a part of the scientific department at Neovation Consultancy Services Pte.
Dr. Vipul Chavda conceived the idea and design for the study and overlooked the entire study until completion. Dr. Santosh Jha made major contributions in drafting the manuscript and statistical analysis. Dr. Dhruvi Hasnani performed statistical analysis on the collected data, wrote and reviewed the manuscript. Vibhuti Jain Rana, Nishtha Singh, and Pusala Lakshmi Prasanna from Neovation Consultancy Services Pte. Ltd., Singapore, for assisting with statistical analysis and manuscript revision.
Sexual dysfunction in men with type II diabetes Caspian J Intern Med.
Al-Saeed AH, Constantino MI, Molyneaux L, D’Souza M, Limacher-Gisler F, Luo C, et al An inverse relationship between age of type 2 diabetes onset and complication risk and mortality: The impact of youth-onset type 2 diabetes Diabetes Care.
Redrow GP, Thompson CM, Wang R. Treatment strategies for diabetic patients suffering from erectile dysfunction: An update Expert Opin Pharmacother. Hatzimouratidis K, Hatzichristou D.
| Patient Category | Recommended Dose | Frequency |
|---|---|---|
| General adult males | 10 mg of tadalafil with 60 mg of dapoxetine | As needed, before sexual activity |
| Elderly patients | Consult doctor; start with lower doses | As prescribed |
| Patients with renal impairment | Dose adjustment needed | Under medical supervision |
How to treat erectile dysfunction in men with diabetes: From pathophysiology to treatment Curr Diab Rep.
[22] Therefore, the effect of comorbidities at baseline was compared with the follow-up values of IIEF parameters of all the treated subjects. [Figure 5] depicts that except for the SD values in individuals without co-morbidities (C–), all other IIEF values significantly improved after the treatment (Tadalafil or Tadalafil + Dapoxetine). On the other hand, in individuals with comorbidities (C+), the effect of both the medications was positive on treatment of ED as seen by the significant improvement of all the IIEF scores. Evaluation of changes in IIEF scores at baseline versus at follow-up in individuals with (C+) and without (C–) comorbidities, who were treated with either Tadalafil or Tadalafil + Dapoxetine drug combination. p < 0.05 was considered statistically significant and indicated with a horizontal bracket DM is considered a possibly life-threatening metabolic disorder with mortalities reported to be associated with complications such as cardiovascular diseases, kidney failure, retinopathy, nephropathy, and neuropathy.
[3] Additionally, ED, reduced sexual desire, orgasmic disorder, and retrograde ejaculation are also a sub-set of complications of variable incidence in men suffering from DM. [1] The objective of the present study was to characterize the major sexual dysfunctions in a single diabetic population, and their inter-associations with other clinical variables and comorbidities. The study investigated the frequency of IIEF scores in 216 men suffering from T2DM. Approximately 41% of the subjects included in this study reported lower than normal SD scores which is a clear indication of ED. This finding resonated with reports dapoxetine spain published in several previous studies. 2014;14:545. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices J Sex Med.
Both Tadalafil and Tadalafil + Dapoxetine improved most of the IIEF parameters. Thus, there appears to be no masking effect on the efficacy of Tadalafil when it is used in combination with Dapoxetine. Moreover, the Tadalafil + Dapoxetine combination improved all the IIEF parameters for subjects with high BMI except for SD. In subjects with co-morbidities, the use of either Tadalafil or Tadalafil + Dapoxetine drug combination was shown to significantly enhance all the IIEF scores, suggesting a strong correlation between comorbidities and ED. The findings of the present study highlight the high prevalence of ED in men suffering from T2DM.
An imbalanced physiological profile, such as higher BMI, higher HbA1c, lower testosterone, disturbed lipid profile, and a lower VitB12 level is reported to be major contributors to ED. In addition to this, the presence of comorbidities such as hypertension, dyslipidemia, and coronary artery disease further elevates the odds of developing ED. The treatment of individuals with T2DM with Tadalafil and Tadalafil + Dapoxetine drug combination shows promising results in improving ED, as analyzed using the IIEF questionnaires. However, no clear advantage of combination of the two drugs was observed. This study lays the foundation of long-term prospective clinical studies to validate the efficacy of using Tadalafil + Dapoxetine drug combination in managing ED in individuals with T2DM. Etiology of erectile dysfunction and duration of symptoms in patients undergoing penile prosthesis: A systematic review Sex Med Rev. Efficacy and safety of dapoxetine/sildenafil combination tablets in the treatment of men with premature ejaculation and concomitant erectile dysfunction-DAP-SPEED study Int J Impot Res.
Dresser M, Desai D, Gidwani S, Seftel A, Modi N.
Two studies, one from the Netherlands and another from the United States indicated that 41.3% and more than 50% of the subjects respectively reported prevalence of ED. [23,24] Thus, low SD is a clear indicator of ED in individuals with DM. The findings of the current study showed that age is significantly associated with ED in individuals with T2DM which is known from the fact that the prevalence of severe ED increases with age. [25] Secondly, obesity is also one of the risk factors for developing ED. [26] Among all subjects enrolled in the current study, 187 (86.6%) had a BMI of more than cut-off of 23 kg/m2 and these subjects showed significantly lower SD values as compared to the individuals with cut-off or lower than cut-off BMI.
A similar observation was also made for other clinical parameters except cholesterol. Reported SD values are significantly lower in subjects who also exhibit imbalanced metabolic profile with high HbA1c, low testosterone, low VitB12, high triglyceride, low HDL, and high LDL. The lipid profile is also a pressing cause of concern in aggravating ED. Findings in this study demonstrate that an imbalance in triglycerides, HDL, and LDL affect the OS scores significantly. Interesting to note is the fact that a raised cholesterol level does not by itself have a direct adverse effect on any of the five domains of the IIEF scores. Dapoxetine, a novel treatment for premature ejaculation, does not have pharmacokinetic interactions with phosphodiesterase-5 inhibitors Int J Impot Res.
(C) A comparison of change in IIEF scores at follow-up with either Tadalafil or Tadalafil + Dapoxetine drug combination. p < 0.05 was considered statistically significant and indicated with a horizontal bracket Role of BMI on the treatment efficacy BMI has a significant effect on the IIEF parameters as seen from this study [Figure 1] as well as previous reports. [21] Therefore, the effect of BMI at cut-off and above cut-off was evaluated for treated individuals at the baseline and at follow-up. Figure 4 shows that Tadalafil-treated individuals having cut-off or below cut-off BMI showed significant improvement only in OS score. Individuals treated with Tadalafil + Dapoxetine who were also having cut-off or below cut-off BMI showed no significant improvement in any of the IIEF scores.
Tadalafil and Tadalafil + Dapoxetine combination treatment improved all the IIEF scores for individuals with above cut-off BMI except for SD values. Effect of BMI and treatment on IIEF scores at baseline and follow-up of treated subjects. At normal BMI (cut-off or below cut-off), the effect of (A) Tadalafil, and (B) Tadalafil + Dapoxetine on IIEF scores. At high BMI (above cut-off), the effect of (C) Tadalafil, and (D) Tadalafil + Dapoxetine on IIEF scores. p < 0.05 was considered statistically significant and indicated with a horizontal bracket Effect of co-morbidities on treatment outcome The effect of comorbidities on ED is not well understood because co-morbidities such dapoxetine tadalafil tablets as hypertension, dyslipidemia, and coronary artery disease can lead to other health problems that can also impact erectile function. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction Int J Impot Res.