The treatment rate of erectile dysfunction (ED) in younger men with type 2 diabetes is up to four times higher than the equivalent non-diabetes population.
Journal
International journal of clinical practice
ISSN: 1742-1241
Titre abrégé: Int J Clin Pract
Pays: India
ID NLM: 9712381
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
16
04
2020
accepted:
14
05
2020
pubmed:
21
5
2020
medline:
22
1
2021
entrez:
21
5
2020
Statut:
ppublish
Résumé
Erectile dysfunction (ED) is common in older age and in diabetes mellitus (DM). Phosphodiesterase type 5-inhibitors (PDE5-is) are the first-line for ED. We investigated how the type of diabetes and age of males affect the PDE5-i use in the primary care setting. From 2018 to 2019, the general practice level quantity of all PDE5-i agents was taken from the general practice (GP) Prescribing Dataset in England. The variation in outcomes across practices was examined across one year, and for the same practice against the previous year. We included 5761 larger practices supporting 25.8 million men of whom 4.2 million ≥65 years old. Of these, 1.4 million had T2DM, with 0.8 million of these >65. About 137 000 people had T1DM. About 28.8 million tablets of PDE5-i were prescribed within the 12 months (2018-2019) period in 3.7 million prescriptions (7.7 tablets/prescription), at total costs of £15.8 million (£0.55/tablet). The NHS ED limit of one tablet/user/wk suggests that 540 000 males are being prescribed a PDE5-i at a cost of £29/y each. With approximately 30 000 GPs practising, this is equivalent to one GP providing 2.5 prescriptions/wk to overall 18 males. There was a 3x variation between the highest decile of practices (2.6 tablets/male/y) and lowest decile (0.96 tablets/male/y). The statistical model captured 14% of this variation and showed that T1DM males were the largest users, while men age <65 with T2DM were being prescribed four times as much as non-DM. Those T2DM >65 were prescribed 80% of the non-DM amount. There is a wide variation in the use of PDE5-is. With only 14% variance capture, other factors including wide variation in patient awareness, prescribing rules of local health providers, and recognition of the importance of male sexual health by GP prescribers might have a significant impact.
Substances chimiques
Phosphodiesterase 5 Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13538Informations de copyright
© 2020 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd.
Références
Nehra A, Jackson G, Miner M, et al. The Princeton III consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87:766-778.
https://bnf.nice.org.uk/treatment-summary/erectile-dysfunction.html. Accessed February 21, 2020.
Balhara YP, Sarkar S, Gupta R. Phosphodiesterase-5 inhibitors for erectile dysfunction in patients with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Indian J Endocrinol Metab. 2015;19:451-461.
Carson CC, Lue TF. Phosphodiesterase type 5 inhibitors for erectile dysfunction. BJU Int. 2005;96:257-280.
Setter SM, Iltz JL, Fincham JE, Campbell RK, Baker DE. Phosphodiesterase 5 inhibitors for erectile dysfunction. Ann Pharmacother. 2005;39:1286-1295.
Smith WB 2nd, McCaslin IR, Gokce A, Mandava SH, Trost L, Hellstrom WJ. PDE5 inhibitors: considerations for preference and long-term adherence. Int J Clin Pract. 2013;67:768-780.
Anderson SG, Hutchings DC, Woodward M, et al. Phosphodiesterase type-5 inhibitor use in type 2 diabetes is associated with a reduction in all-cause mortality. Heart. 2016;102:1750-1756.
Hackett G, Heald AH, Sinclair A, Jones PW, Strange RC, Ramachandran S. Serum testosterone, testosterone replacement therapy and all-cause mortality in men with type 2 diabetes: retrospective consideration of the impact of PDE5 inhibitors and statins. Int J Clin Pract. 2016;70:244-253.
Andersson DP, Trolle Lagerros Y, Grotta A, Bellocco R, Lehtihet MJ. Association between treatment for erectiledysfunction and death or cardiovascular outcomes after myocardial infarction. Heart. 2017;103:1264-1270. GP Practice.
Prescribing Presentation-level Data. NHS Digital. https://digital.nhs.uk/catalogue. Accessed February 22, 2020.
https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/national-diabetes-audit. Accessed February 29, 2020.
Hackett G, Kember LE. Barriers to knowledge, awareness, and diagnosis of erectile dysfunction and low testosterone in men: survey of 1,019 men and 222 general practitioners in the UK. J Sex Med. 2011;8:433.
Corona G, Giorda CB, Cucinotta D, Guida P, Nada E. SUBITO-DE Study Group. Sexual dysfunction in type 2 diabetes at diagnosis: progression over time and drug and non-drug correlated factors. PLoS One. 2016;11:e0157915.
Fedele D, Coscelli C, Cucinotta D, et al. Incidence of erectile dysfunction in Italian men with diabetes. J Urol. 2001;166:1368-1371.
De Berardis G, Pellegrini F, Franciosi M, et al. QuED Study Group. Clinical and psychological predictors of incidence of self-reported erectile dysfunction in patients with type 2 diabetes. J Urol. 2007;177:252-257.
Lee TM, Chen CC, Chung TH, Chang NC. Effect of sildenafil on ventricular arrhythmias in post-infarcted rat hearts. Eur J Pharmacol. 2012;690:124-132.