Article Text

  1. J. L. Meier1,
  2. A. L.M. Swislocki2,3,
  3. R. H. Noth2,3
  1. 1Pharmacy
  2. 2Medicine Services, VA Northern California Health Care System, Martinez, CA
  3. 3Department of Internal Medicine, University of California, Davis, Davis, CA.


Based on reports in the literature, the estimated prevalence of erectile dysfunction (ED) is over 50% in men with diabetes. In the VA Northern California Health Care System (VANCHCS) in 1996, prior to use of alprostadil and sildenafil, only 2% of our male veterans with diabetes (MVDM) were receiving any therapy (Rx) for ED. By 2001, this figure had increased, but only to 9%, mostly due to use of sildenafil (begun in 2000). With alprostadil and phosphodiesterase 5 (PDE-5) inhibitors on formulary in VANCHCS for 6+ years, free or at minimal cost ($7/4doses/month) and widely promoted in the media, prescriptions for these are likely to reflect current demand for Rx of ED. To assess this in our system in the past year (7/1/2005-6/30/2006) and back to 1996, VA computer-based records were examined for prescriptions for all pharmacologic Rx for ED and for orders for vacuum devices and ICD-9 codes for penile implants. MVDM were identified by use of hypoglycemic agents (7/1/2005-6/30/2006). The study group was composed of 8,894 MVDM and 39,827 male veterans without diabetes (MVnoDM) who received at least one prescription of any kind in the time interval. Fewer than 1% received nonpharmacologic ED Rx and were excluded from the analysis; 1,388 (16%) of MVDM received at least one prescription for a PDE-5 and 1,503 (17%) received any ED agent in the past year, almost double the treatment rate in 2001. An additional 1,102 (42% of those ever treated) received treatment in the past but dropped out before this past year. MVDM treated for ED were younger (62 ± 8 vs 67 ± 11 years; p < .001) than those not treated and had a slightly higher HbA1c (7.6 ± 1.5 vs 7.3 ± 1.5; p < .001). Of MVDM not treated for ED in the past year, 1,194 received a prescription for nitrates that year. Of MVnoDM, only 5,268 (13%) received any ED pharmacotherapy in the past year; dropouts were only 2,970 (36%) (p < .001 vs MVDM). Thus, PDE-5 agents have had a major impact on Rx for ED in VANCHCS, but based on estimated prevalence, ED is still often untreated in DM. Comorbidity, including coronary artery disease treated with nitrates, may account in part for relatively low demand and higher dropout. Even so, the use of these agents in men with diabetes is substantially higher than in men without, supporting an increased prevalence of ED in men with diabetes.

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