Cardiovascular autonomic neuropathy, erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes: findings from the DCCT/EDIC

Abstract

Purpose: We evaluated the association between cardiovascular autonomic neuropathy, and erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes.

Materials and methods: Male type 1 diabetes participants (635) in the DCCT/EDIC were studied. Cardiovascular autonomic neuropathy was assessed by standardized cardiovascular reflex tests including changes in respiratory rate variation with deep breathing, Valsalva maneuver (Valsalva ratio) and changes in supine to standing diastolic blood pressure. Erectile dysfunction was assessed by a proxy item from the International Index of Erectile Function, and lower urinary tract symptoms were assessed with the AUASI (American Urological Association Symptom Index). Multivariable logistic regression models estimated the association between cardiovascular autonomic neuropathy and erectile dysfunction and/or lower urinary tract symptoms, adjusting for time weighted glycemic control, blood pressure, age and other covariates.

Results: Men in whom erectile dysfunction and/or lower urinary tract symptoms developed during EDIC had a significantly lower respiratory rate variation and Valsalva ratio at DCCT closeout and EDIC year 16/17 compared to those without erectile dysfunction or lower urinary tract symptoms. In adjusted analysis, participants with cardiovascular autonomic neuropathy had 2.65 greater odds of erectile dysfunction and lower urinary tract symptoms (95% CI 1.47-4.79).

Conclusions: These data suggest that cardiovascular autonomic neuropathy predicts the development of urological complications in men with long-standing type 1 diabetes. Studies evaluating the mechanisms contributing to these interactions are warranted for targeting effective prevention or treatment.

Trial registration: ClinicalTrials.gov NCT00360815 NCT00360893.

Keywords: diabetes mellitus; erectile dysfunction; hereditary sensory and autonomic neuropathies; lower urinary tract symptoms.

Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Neuropathy and ED/LUTS data collection in DCCT/EDIC.

Figure 2

ED and/or LUTS Status in Male Participants of UroEDIC II at EDIC Year 17.

Figure 3

Prevalence of CAN at DCCT closeout and EDIC year 16/17 by ED and LUTS status at EDIC year 17. Abnormal CAN function defined as either R-R variationor R-R variation between 15–19·9 plus either a Valsalva ratio≤1·5 or a supine-to-standing drop of 10 mm Hg in diastolic blood pressure.