The association between prediabetes and male sexual dysfunction: an updated meta-analysis.

BACKGROUND

Prediabetes, defined as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), is recognized as an increasing metabolic disorder globally. Although its vascular and metabolic implications are well established, the link between prediabetes and male sexual dysfunction is uncertain. This meta-analysis was performed to summarize available evidence on the relationship between prediabetes and sexual dysfunction in men.

METHODS

A systematic literature search of PubMed, Embase, and Scopus from inception to July 2025 was undertaken to retrieve observational studies reporting sexual dysfunction outcomes (erectile dysfunction or premature ejaculation) in prediabetic men. The eligibility criteria were adult men with prediabetes and comparative data with normoglycemic controls. Studies were screened by two independent reviewers who also extracted data and evaluated study quality using the Newcastle-Ottawa Scale (NOS). Meta-analysis with random effects model was employed to combine effect sizes and assess heterogeneity on the basis of I² statistic. Funnel plots and Egger's test were employed to investigate publication bias. GRADE approach was applied to grade the certainty of the evidence according to risk of bias, inconsistency, indirectness, imprecision, and publication bias.

RESULTS

A total of ten studies with 11,000 participants were available for analysis. Combined odds ratio (OR) of sexual dysfunction in prediabetic men compared to normoglycemic men was 2.50 (95% CI: 1.35-4.64), indicating significant association with high heterogeneity (I² = 87.9%, p<0.001). Funnel plot asymmetry was checked by visual inspection and confirmed by Egger's regression test for publication bias, which was not significant (p=0.275). According to GRADE, the quality of evidence was generally low, downgraded for high heterogeneity and imprecision but upgraded for large effect size.

CONCLUSIONS

We found that men with prediabetes have approximately 2.5-fold higher odds of sexual dysfunction than men with normoglycemia. Due to the high pooled effect size, although with low certainty of evidence, additional high-quality prospective studies are needed to replicate findings and explore the underlying mechanisms.