Diabetes is associated with an increased risk for a number of serious complications, but the most dreaded among men-and least talked about-is erectile dysfunction.
Like high cholesterol and hypertension, diabetes can contribute to changes in erections because it affects the vascular system. Diabetes can cause a cascade of events that lead to the thickening of arteries and restriction of blood flow. Without enough blood flowing to the penis, erectile problems often occur.
More than half of men with diabetes experience decreased erectile function within 10 years of being diagnosed with diabetes. Some researchers estimate that the prevalence may be as high as 75%, rising to 95% for men over age 70. The presence of heart disease and hypertension further increases the prevalence of erectile dysfunction in men with diabetes, according to researchers at Harvard University School of Medicine.
"Many Type 2 diabetes patients have insulin resistance for 10 to 15 years before they are diagnosed," explained R. Keith Campbell, B.Pharm., MBA, CDE, professor at Washington State University's college of pharmacy in Spokane, Wash. "Because patients are unaware that their glucose levels have been elevated for a long period, they are not doing anything to stay in control or to reduce the risk of erectile dysfunction."
Campbell added that once a man has erectile dysfunction, better management of diabetes is not going to improve the situation. "The damage has usually been done and it can't be undone," he said. "That's why I think it's important that we tell men in their 30s and 40s to take better care of their cholesterol, blood pressure, and diet so they can prevent the development of erectile dysfunction."
Despite the obvious physiological signs of erectile dysfunction, it often goes undiagnosed and untreated because it can be a difficult topic to discuss not only with a spouse but also with healthcare professionals.
"Many patients are reluctant to talk about it at all," said Stuart Haines, Pharm.D., professor and vice chair for education at University of Maryland's school of pharmacy in Baltimore. "They are not likely to bring it up to a pharmacist at a counter with other people standing around." With many pharmacists playing a greater role in educating patients about diabetes, there are opportunities to initiate a conversation about the signs, symptoms, and treatments of the disease, he added.
At the Joslin Diabetes Center in Baltimore, where Haines works, sexual performance is one of many routine questions during the interview process. "We ask them in the questionnaire about their sexual health and whether they are having any problems during sexual intercourse."
At Ukrop's Pharmacy in Glen Allen, Va., pharmacists hold classes with newly diagnosed diabetes patients and talk about erectile dysfunction as a complication of diabetes. "We especially try to talk to men over the age of 40 about it," said Tim Robertson, R.Ph., CDE. "There are some men who don't want to talk about it, but it's not a taboo subject given the whole Viagra phenomenon," he said. "It's not as big a deal to most men as it used to be."
Haines recognizes that it's a difficult subject for pharmacists to bring up unless there is a private counseling room. For female pharmacists, he said, the topic can be particularly difficult to initiate with patients. "The cross-gender discussions of erectile dysfunction are fraught with subtle difficulties."