Hidden metabolic risk in erectile dysfunction: Prevalence of undiagnosed diabetes mellitus, prediabetes, and metabolic syndrome.

AIM: We aimed to determine the prevalence of undiagnosed impaired glucose metabolism (IGM) and metabolic syndrome (MetS) in men presenting with erectile dysfunction (ED) and to assess whether ED severity is associated with specific IGM subgroups.

METHODS

605 consecutive men aged ≥ 18 years presenting with ED were evaluated for inclusion. Patients with known IGM, chronic diseases, antiandrogen use or prior testicular, pituitary, or prostate surgery were excluded. ED severity was assessed using the 5-item International Index of Erectile Function (IIEF-5). Clinical data, anthropometrics, and laboratory measurements were obtained.

RESULTS

Of the 310 patients included in the study, MetS was identified in 94 (30.3%) and IGM in 82 (26.4%), including 28 newly diagnosed with diabetes mellitus (DM) (9.0%) and 54 with prediabetes (17.4%). Among patients with prediabetes, 29 (53.7%) had impaired fasting glucose (IFG), 4 (7.4%) had both IFG and impaired glucose tolerance (IGT), and 21 (38.9%) had HbA1c levels of 5.7-6.4%. IGM prevalence differed significantly by ED severity categories; 23 (28%) mild, 39 (47.6%) mild-to-moderate, 17 (20.7%) moderate, and 3 patients (3.7%) with severe ED (p = 0.042). Testosterone levels were significantly lower in patients with MetS (p < 0.001). IIEF-5 score demonstrated a statistically significant but modest ability to predict IGM and MetS (p = 0.008 and p = 0.047). While age was an independent predictive factor for the mild, mild-to-moderate, and moderate ED categories, MetS and prediabetes were independently predictive in patients with mild-to-moderate ED.

CONCLUSIONS

Newly diagnosed IGM and MetS were identified in nearly one-third of patients presenting with ED, most frequently in those with mild-to-moderate symptoms. These findings suggest that ED, particularly in milder forms, may indicate underlying metabolic risk and warrant careful evaluation.