High Prevalence of Erectile Dysfunction in Diabetic Men With Depressive Symptoms: A Meta-Analysis.

BACKGROUND: Erectile dysfunction (ED) may be common among diabetic men with depressive symptoms (DS), but its prevalence is still debated.

AIM: To conduct a meta-analysis of the prevalence of ED in diabetic men with DS compared to those without DS, calculating the relative odds ratios (ORs) and 95% CIs.

METHODS: PubMed, MEDLINE, Embase, and Web of Science were searched up to January 2018. All the studies assessing the risk of ED among diabetic men having DS were reviewed. 2 Authors independently assessed literature and extracted information eligibility. Any disagreement was resolved by a third reviewer. Newcastle-Ottawa quality assessment scale was used to evaluate study quality in meta-analyses. We calculated the ORs with 95% CIs using software Stata, Version 12.0; StataCorp, College Station, TX). Data were pooled using a fixed or random effects model according to heterogeneity. Sensitivity analyses were conducted to assess potential bias. This study was conducted according to the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies.

OUTCOMES: The strength of the association between DS and the prevalence of ED was evaluated using ORs and 95% CIs.

RESULTS: 5 Studies were eligible for the present analysis, reporting on a total of 2525 diabetic men. Mean age of patients ranged from 42.37-61.65 years in the included studies. The overall prevalence of ED in diabetic men with DS was 74.2% (95% CI 59.0-89.4). The overall prevalence of ED in diabetic men without DS was 37.4% (95% CI 16.2-58.6). The pooled crude OR for these 5 studies was 6.40 (95% CI 2.11-19.38, P < .05, I2  = 94.6%). The pooled OR of 4 multi-variate analyses was 3.08 (95% CI 1.32-4.85, P < .001, I2  = 83.5%).

CLINICAL IMPLICATIONS: Diabetic men with DS had a significantly increased prevalence of ED, suggesting that ED should be of concern to clinicians when managing diabetic men with DS.

STRENGTHS & LIMITATIONS: A strength of this study is that it is the first meta-analysis to assess the prevalence of ED in diabetic men with DS and quantitatively analyze the association between DS and ED risk among diabetic men. A limitation is that all included studies were cross-sectional studies, which may generate bias.

CONCLUSION: The present meta-analysis of 5 cross-sectional studies suggests that diabetic men showing DS, compared to the diabetic men without DS, have more risk of ED. Further larger prospective cohorts with more power or meta-analysis based on individual patient data need to be conducted to confirm this association. Wang X, Yang X, Cai Y, et al. High Prevalence of Erectile Dysfunction in Diabetic Men With Depressive Symptoms: A Meta-Analysis. J Sex Med 2018;15:935-941.