The relationship of retinal vessel caliber with erectile dysfunction in patients with type 2 diabetes.

PURPOSE: To investigate the relationship of retinal vessel caliber with erectile dysfunction (ED) in males with type 2 diabetes. METHODS: A hospital-based cross-sectional study. Male patients with type 2 diabetes were recruited from the Diabetic Management Project. All underwent a complete eye examination, a comprehensive interview, and blood and urine tests. Retinal vessel diameter was measured from retinal photographs by trained graders using semiautomated software. ED was defined as problems achieving or maintaining an erection and was assessed using a self-reported questionnaire. RESULTS: A total of 289 male patients with a mean (±SD) age of 65.3 years (±11.2) were assessed. After adjusting for age, diastolic blood pressure, duration of diabetes, HbA1c, total cholesterol, presence of diabetic retinopathy, and any diabetic complication, narrower retinal arteriolar diameter (odds ratio [OR] 1.66; 95% confidence interval [CI] 1.09-2.54; P = 0.019) and wider venular diameter (OR 1.58; 95% CI 1.03-2.44; P = 0.038) were associated with ED. CONCLUSIONS: Narrower retinal arteriolar and wider venular diameter are independently associated with an increased risk of self-reported ED. These results suggest a microvascular component in the pathogenesis of this condition.

Relationship between diabetic retinopathy, diabetic macular oedema and erectile dysfunction in type 2 diabetics.

BACKGROUND: To investigate the relationship of diabetic retinopathy and diabetic macular oedema with erectile dysfunction in patients with type 2 diabetes. DESIGN: Hospital-based, cross-sectional study. PARTICIPANTS: Three hundred twenty-four men with diabetes from the Diabetic Management Project were recruited. METHODS: Participants underwent a comprehensive interview, a complete eye examination, fasting blood tests, and had retinal and macula assessments using fundus images and optical coherence tomography, respectively. Diabetic retinopathy was categorized as none, mild, moderate, severe non-proliferative and proliferative, and diabetic macular oedema as none, mild, moderate and severe. Erectile dysfunction was defined as problems achieving or maintaining an erection and was assessed using a self-reported questionnaire. MAIN OUTCOME MEASURES: Erectile dysfunction. RESULTS: The mean ± standard deviation age of 324 men with type 2 diabetes was 65.2 ± 11.1 years. Compared with patients without diabetic retinopathy, those with any retinopathy (odds ratio 2.06, 95% confidence interval 1.22-3.48, P = 0.007) had a twofold increased odds of having erectile dysfunction. Patients with severe non-proliferative diabetic retinopathy (odds ratio 4.39, 95% confidence interval 1.48-13.0, P = 0.008) and proliferative diabetic retinopathy (odds ratio 2.74, 95% confidence interval 1.44-5.19, P = 0.002) had fourfold and threefold increased odds of having erectile dysfunction, respectively, compared with those without diabetic retinopathy. Diabetic macular oedema, irrespective of presence or severity, was not independently associated with erectile dysfunction. CONCLUSION: The presence and severity of diabetic retinopathy but not diabetic macular oedema are independently associated with self-reported erectile dysfunction.

Impact of diabetic retinopathy on patients' beliefs about diabetes.

BACKGROUND: The aim was to compare beliefs about diabetes and determine their associations with psychological well-being, self-management behaviour and glycaemic control in those with and without diabetic retinopathy (DR). METHODS: We recruited 400 patients with diabetes aged 18 years or more from specialised eye clinics, as part of the Diabetes Management Project (DMP). Two-field retinal photographs were taken to assess DR and detailed clinical and psychological well-being examinations were performed following standardised procedures. Glycaemic control was determined using glycated haemoglobin levels. We assessed beliefs about diabetes (diabetes-specific version of the Revised Illness Perception Questionnaire [IPQ-R]), self-management behaviour (Summary of Diabetes Self Care Activities [SDSCA]) questionnaire) and depression and anxiety (the Hospital Anxiety and Depression Scale [HADS]). RESULTS: Patients with DR (n = 256, 64 per cent) believed that they experienced more symptoms related to their diabetes, that diabetes had a greater impact on their life and that this condition was more unpredictable compared with those without DR (p < 0.05 for all). Patients with DR were also more engaged in glucose testing compared with those without DR. Furthermore, negative beliefs about diabetes were significantly associated with higher levels of depression and anxiety (p < 0.01) but not glycaemic control, regardless of DR and other diabetic complications. CONCLUSIONS: Patients with DR had more negative beliefs about diabetes than those without. We identified strong and consistent associations between negative beliefs and psychological outcomes regardless of diabetic complications. These findings suggest that management for patients with DR could include strategies to address negative beliefs about diabetes and manage the emotional implications of diabetes in addition to medical treatment.