Diagnosis and treatment of erectile dysfunction in patients with type 1 diabetes mellitus

Objective. To study serum glucose fluctuations using continuous glycemia monitoring in a “blind” mode for 7 days; to adjust the insulin therapy in accordance with these results and improve the outcomes in patients with diabetes mellitus and erectile dysfunction. Material and methods. The study involved 21 patients aged 23—46 years with erectile dysfunction (ED) and concomitant insulin-dependent diabetes mellitus (DM type 1). In all patients, we assessed androgen deficiency and performed neurological examination of neuropathies and status of autonomic nervous system. Perineal needle electromyography (EMG) was used to identify hidden neurogenic disorders. We assessed mean duration and amplitude of muscle unit action potential (MUAP), the number of polyphasic potentials, fibrillation potentials and positive sharp waves (PSW). Neurophysiological examination of lower limb muscles corresponding to target spinal cord segments was performed to assess the prevalence of denervation processes and involvement of large nerves and somatic muscle structures. Corticospinal tract conductivity under transcranial magnetic stimulation was assessed by recording the motor response time from the muscles of the lower extremities and perineum and calculating the central motor conduction time. Results. All patients had severe disorders of regional hemodynamics and innervation of the penis and pelvic organs without significant endocrine changes. Daily monitoring of glucose fluctuations revealed recurrent episodes of hyperglycemia both at rest and during sexual intercourse. Therapy for ED necessarily implied individual correction of glycemia, as well as therapy for microangiopathy, neuropathy and autonomic pelvic dysfunctions. Correction of hyperglycemia had a positive effect on genital hemodynamics and innervation of perineal muscles as evidenced by repeated neurophysiological and ultrasound examination. Conclusion. Adequate and timely adjustment of insulin therapy significantly improves the effectiveness of ED treatment. Daily glucose monitoring in these patients is a new and effective step towards a personalized treatment of type 1 diabetes and concomitant ED.