How should patients with ED associa-ted with diabetes mellitus be counseled?

Since diabetes is a common risk factor for ED,  all patients presenting with ED should be  screened for elevations in fasting glucose. In  a recent study, Lewis noted that 12% of  patients presenting with ED had pre-existing  underlying diabetes [44]. ED associated with  diabetes is often severe and typically presents  at a younger age than ED in the general population.  For example, Nicolosi found that the  incidence of ED in men with diabetes age 45 to  49 was similar to the incidence of ED in nondiabetic  men over 70 [45]. 

Since ED often presents at a younger age in  men with diabetes, the impact of ED on quality  of life is likely greater in thesemen. Despite  the impact, men with diabetes and ED are  reluctant to proactively discuss erectile function  with healthcare professionals. On the  other hand, practitioners also seem to be  reluctant to broach the subject with their  patients. Nicolosi found that only 14.4% of  men with diabetes were asked about sexual  health during a routine medical visit [45].  Therefore, annual health maintenance screening  in men with diabetes should include questions  about erectile function, along with  efforts to improve glycemic and lipid control,  normalize blood pressure, and screen for  microvascular complications. Early detection  of ED—prior to diabetes-associated endothelial  cell and nerve function damage—allows for a  more robust response to PDE5 inhibition and  is rewarding to the patient, partner, and physician  alike.