Background: Erectile dysfunction (ED) is a frequent and prevalent complication among patients with type 2 diabetes mellitus (T2DM) and is widely regarded as an independent risk factor for cardiovascular disease (CVD) in this population.
Objectives: To determine whether specific glucose-lowering agents influence ED and to identify the optimal therapeutic approach for T2DM patients with ED.
Methods: This cross-prospective study enrolled 195 male patients with confirmed T2DM evaluated for ED. Comprehensive clinical and metabolic assessment included age, body mass index (BMI), family history of diabetes mellitus, duration of diabetes, smoking status, physical activity, dyslipidemia, cardiovascular comorbidities, serum testosterone, and glycated hemoglobin (HbA1c). Erectile function was assessed using the validated International Index of Erectile Function-5 (IIEF-5) questionnaire. Due to the heterogeneity of antidiabetic therapy, subjects were stratified according to the pharmacological regimen.
Results: The mean IIEF-5 score was 14.4 ± 5.8 (range 4–25). Significant correlations were observed between ED severity and increasing age, longer diabetes duration, presence of comorbidities, and smoking. The highest mean IIEF-5 scores were documented in patients receiving insulin combined with sodium-glucose cotransporter-2 inhibitors (SGLT2i) and metformin, followed by sulfonylurea plus SGLT2i with metformin. The lowest mean score was observed in the dipeptidyl peptidase-4 inhibitor (DPP4i) plus metformin group.
Conclusions: ED in T2DM is significantly associated with age, disease duration, comorbidities, and smoking. The addition of SGLT2i within intensive glycemic control regimens demonstrated improvement in erectile function among patients with diabetes.