Prevalence and clinical characteristics of erectile dysfunction among men with type 2 diabetes in primary care: A cross-sectional study in Catalonia.

Abstract

We assessed the prevalence and risk factors of erectile dysfunction (ED) in men with type 2 diabetes (T2DM) compared with men without diabetes in Catalonia, Spain. This cross-sectional study used routinely collected primary care data from the SIDIAP database (covering ∼80% of the Catalan population) from 1st January 2010-30 th June 2023. Men ≥ 18 years with at least one primary care visit and one recorded laboratory test were included. T2DM was identified through ICD-10 codes, antidiabetic drugs, or HbA1c ≥ 6.5%; men without diabetes had no recorded diagnosis or criteria for any diabetes. ED was defined by ICD-10 codes (F52, N48.9) and/or prescriptions for approved ED treatments. Sociodemographic, lifestyle, clinical and laboratory data, comorbidities and medications were extracted. Multivariable logistic regression assessed factors associated with ED. Among 659,501 men (177,380 with T2DM; 492,121 without), overall ED prevalence was 9.5%. Prevalence was 1.5-fold higher in T2DM (12.6%) than in men without diabetes (8.3%), peaking at 55-64 years. Older age, longer diabetes duration, poorer glycaemic control, smoking, high-risk alcohol use, hypertension, dyslipidaemia, cardiovascular and microvascular disease, obesity and depression were independently associated with ED. Men with T2DM show markedly higher ED prevalence and multiple cardiometabolic risk factors. ED remains under-recognised and should be systematically assessed in primary care as both a complication and a clinical marker of cardiometabolic risk.