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Canadian Diabetes Association Clinical Practice Guidelines Canadian Diabetes Association Clinical Practice Guidelines

Canadian Diabetes Association Clinical Practice Guidelines - PowerPoint Presentation

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Canadian Diabetes Association Clinical Practice Guidelines - PPT Presentation

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

diabetes men dysfunction grade men diabetes grade dysfunction contraindications sexual regularly adult screen inhibitors 2013 consensus level pde5 function

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Slide1

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

Disclaimer

All Content contained on this slide deck is the property of Diabetes Canada, its content suppliers or its licensors as the case may be, and is protected by Canadian and international copyright, trademark, and other applicable laws. Diabetes Canada grants personal, limited, revocable, non-transferable and non-exclusive license to access and read content in this slide deck for personal,

non-commercial

and not-for-profit use only. The slide deck is made available for lawful, personal use only and

not for commercial use

.

The unauthorized reproduction, distribution of this copyrighted work is not permitted.

For

permission to use this slide deck for commercial or any use other than personal, please contact

guidelines@diabetes.ca

Slide3

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