Erectile Dysfunction Chapter 33 Gerald Brock William Harper Erectile Dysfunction ED Checklist SCREEN all adult men regularly with sexual function history INVESTIGATE for hypogonadism ID: 272025
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Sexual Dysfunction and Hypogonadism in Men with Diabetes
Chapter 33Richard Bebb MD ABIM FRCPC, Adam Millar MD MScCH FRCPC, Gerald Brock MD FRCSC
2018 Clinical Practice GuidelinesSlide2
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Key Changes
Reinforcement of The importance of regular screening for erectile dysfunction in adult men with diabetesTiming of testosterone measurements (before 11 AM)New section on hypogonadism including a diagnostic workup algorithm
2018
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Slide4
Erectile Dysfunction (ED) Checklist
SCREEN all adult men with diabetes regularly with sexual function historyTREAT erectile dysfunction with PDE-5 inhibitor as first-line therapy (if no contraindication)
INVESTIGATE
for hypogonadism if men with ED do not respond to PDE-5 inhibitor therapy
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
PDE-5, phosphodiesterase type 5Slide5
ED affects 34-45% of men with diabetes
40% of men >60 years with diabetes have complete EDED negatively impacts quality of life
Common
+ Important
Screen all adult men with diabetes regularly as part of sexual function history
Screen for ED
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
ED
, erectile dysfunctionSlide6
Management of erectile dysfunction in men with diabetes
ED,
erectile dysfunction
; PDE5,
phosphodiesterase type 5
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
2018Slide7
opioid use
2018Slide8
Recommendations 1-2
All adult men with diabetes should be regularly screened for ED with a sexual function history [Grade D, Consensus]A PDE5 inhibitor should be offered as first-line therapy
to men with diabetes and ED in either an on-demand
[Grade A, Level 1A]
or daily-use
[Grade B, Level 2]
dosing regimen
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
ED,
erectile dysfunction
; PDE5,
phosphodiesterase type 5Slide9
Recommendation 3
3. Men with diabetes and ED who do not respond to PDE5 inhibitors should be investigated for hypogonadism with measurement of a morning serum total testosterone level drawn before 11 am [Grade D, Level 4]
2
2018
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
ED,
erectile dysfunction
; PDE5,
phosphodiesterase type 5Slide10
Recommendations 4-5
Referral to a specialist in ED should be considered for eugonadal men who do not respond to PDE5 inhibitors or for whom the use of PDE5 inhibitors is contraindicated [Grade D, Consensus]Men with diabetes and ejaculatory dysfunction who are interested in fertility should be referred to a healthcare professional experienced in the treatment of ejaculatory dysfunction
[Grade D, Consensus]
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
ED,
erectile dysfunction
; PDE5,
phosphodiesterase type 5Slide11
Erectile dysfunction affects approximately 34 to 45%
of adult men with diabetes. It has been demonstrated to negatively impact quality of life among those affected across all age strata and may be an early clinical indication of CVDAll adult men with diabetes should be regularly screened for ED with a sexual function history
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
Key Messages
Regarding Sexual Dysfunction in Men with Diabetes
ED,
erectile dysfunction
; CVD,
cardiovascular diseaseSlide12
The current mainstay of therapy for ED is PDE5 inhibitors
. They have been shown to have major impacts on erectile function and quality of life, with a low reported side effect profile, and should be offered as first-line therapy to men with diabetes wishing treatment for ED
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
Key Messages
Regarding Sexual Dysfunction in Men with Diabetes
ED,
erectile dysfunction
; PDE5,
phosphodiesterase type 5Slide13
Key Messages Regarding Hypogonadism in Men with Diabetes
Hypogonadotropic hypogonadism is common in men with type 2 diabetes, with a prevalence of up to 40%Hypogonadal men with diabetes have a higher risk for CV mortality than eugonadal men with diabetesScreening for symptomatic hypogonadism in men with type 2 diabetes is recommended
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes
CV,
cardiovascular Slide14
Key Messages for People with Diabetes
Low testosterone is common in men with type 2 diabetesSymptoms of low testosterone can include: diminished interest in sex, erectile dysfunction, reduced lean body mass, depressed mood and lack of energyA decrease in sexual function may indicate your risk of cardiovascular disease is increasing If you are experiencing symptoms of low testosterone, you should talk with your health-care provider
2018 Diabetes Canada CPG – Chapter 33. Sexual Dysfunction & Hypogonadism in Men with Diabetes Slide15
Visit guidelines.diabetes.ca
Slide16
Or download the AppSlide17
Diabetes Canada Clinical Practice Guidelines
http://guidelines.diabetes.ca – for health-care providers1-800-BANTING (226-8464)http://diabetes.ca
– for people with diabetes