Regular screening for erectile dysfunction may identify young men with undiagnosed prediabetes and type 2 diabetes.

Erectile dysfunction in young men may be a signal that they have undiagnosed prediabetes or type 2 diabetes, according to new research.

 It may also signify that they are at a high risk of developing prediabetes or type 2 diabetes.

“This indicates a remarkable ability to predict the potential onset of illness and treat it early with lifestyle or medication,” Jane Tucker, MD., associate professor of family and community medicine at Saint Louis University and lead author of the study, said in a press release.   

The study, “Erectile dysfunction associated with undiagnosed prediabetes and type 2 diabetes in young adult males: A retrospective cohort study”, was published in Preventive Medicine.

Erectile dysfunction, sometimes called impotence, occurs when men have difficulty achieving or maintaining an erection during sexual activity. It can occur for many reasons, including heart disease, diabetes, low testosterone, metabolic syndrome or as a side effect of medications used to treat high blood pressure, pain, ulcers, cancer and depression.

The Centres for Disease Control (CDC) estimates that 8.5 million adults have undiagnosed diabetes; a quarter of these cases are among young people aged 18-44. Other studies show that the rate of erectile dysfunction in men under age 40 is rising and is currently estimated at 30%. Observational studies have found a link between erectile dysfunction, prediabetes and type 2 diabetes. However, it is unclear if erectile dysfunction is a marker of undiagnosed prediabetes and type 2 diabetes or whether it is a risk factor for prediabetes and type 2 diabetes.

“The present study was designed to first determine the risk for prediabetes and or T2D among young men with and without a new ED diagnosis, and second, determine the time between new ED diagnosis and onset of pre-diabetes/T2D”, the researchers wrote.

Participants were young men (aged 18-40 years) with electronic health records on Saint Louis University-SSM (SLU-SSM) healthcare System’s Virtual Data Warehouse between 2008 and 2022. The participants had visited the outpatient clinic at least once in the two years before they were diagnosed with erectile dysfunction and did not have a previous diagnosis of prediabetes, type 1 or type 2 diabetes or take medications for these conditions.

A total of 231 523 men (3131 with erectile dysfunction, 81.7% White and 14.3% Black) participated in the study. Men with erectile dysfunction were more likely to be over age 30, with low testosterone, obesity, high blood pressure, high cholesterol, depression and anxiety, and take blood pressure medication and anti-depressants than men without erectile dysfunction.

Primary care clinicians should routinely screen for hyperglycaemia [high blood sugar] when younger patients present with ED [erectile dysfunction].

The rate of prediabetes or type 2 diabetes was 8.1% among men with erectile dysfunction, compared with 3.2% among those without erectile dysfunction. Notably, men with erectile dysfunction had a 2.57-fold higher risk of prediabetes and type 2 diabetes than those without erectile dysfunction.

About a third of men were diagnosed with erectile dysfunction and prediabetes, or type 2 diabetes, on the same day, and nearly 50% within one month (including on the same day). The majority (about 75%) developed prediabetes or type 2 diabetes within a year of their erectile dysfunction diagnosis.

“Although ED and T2D are known to co-occur, the present study advances prior evidence by establishing the temporal association and lag time from ED to prediabetes/T2D diagnosis,” the researchers wrote.

Scientists do not fully understand the relationship between erectile dysfunction and type 2 diabetes, but they believe it is connected to insulin resistance and carrying excess fat around the abdomen. Of note, insulin resistance is when the body’s cells do not respond to insulin as they should. They also believe that excess body fat can reduce sex hormones, particularly DHEA, and possibly increase the risk of erectile dysfunction.

“ED may offer the opportunity for primary care physicians to make an earlier diagnosis of T2D, particularly in younger men,” the scientists wrote.

“Primary care clinicians should routinely screen for hyperglycaemia [high blood sugar] when younger patients present with ED,” they concluded.