• Abdul Ghafoor Department of Endocrinology and Metabolism, Services Hospital, Lahore
  • Syed Muhammad Hammad Zaidi Department of Endocrinology and Metabolism, Services Hospital, Lahore
  • Amena Moazzam Department of Endocrinology and Metabolism, Services Hospital, Lahore


Background: Among diabetic patients autonomic neuropathy (AN) is one of the most frequent complications. This affects peripheral nervous system and thus results into erectile dysfunction (ED). The main objectives of the study were to determine the frequency of autonomic neuropathy (AN) in diabetic patients with ED and to find out the associated risk factors. Methods: In this descriptive case series, a total 200 consecutive patients of Diabetes Mellitus with erectile dysfunction attended the Department of Endocrinology and Metabolism (DEM), Services Hospital Lahore during three months (from June to August 2013), were included. For assessing erectile dysfunction (ED) and autonomic neuropathy (AN) International Index of Erectile Function (IIEF) and Composite Autonomic Scoring System (CASS) were used respectively. Other factors impacting the autonomic functions in diabetes like duration of diabetes, age of patient, body mass index (BMI), and glycaemic control (HbA1c), hypertension and smoking status were recorded. Results: Average age of the patients was 57.58±9.53 years (95% C.I. 55.54-59.63). Frequency of autonomic neuropathy (AN) in ED patients was 86 (43%). Duration of diabetes Mellitus and BMI were statistically significantly different among patients with severe, moderate and mild autonomic neuropathy. Conclusions: Autonomic neuropathy was very frequent in diabetic patients with erectile dysfunction. The associated risk factors are duration of disease and body mass index.


Foss-Freitas MC, Marques Junior W, Foss MC. [Autonomic neuropathy: a high risk complication for type 1 Foss-Freitas MC, Marques Junior W, Foss MC. [Autonomic neuropathy: a high risk complication for type 1 diabetes mellitus]. Arq Bras Endocrino Metabol 2008;52(2):398–406.

Bruna J, Navarro X. [Autonomic neuropathy in diabetes mellitus]. Rev Neurol 2005;40(2):102–10.

Millan-Guerrero RO, Vasquez C, Isais-Millan S, Trujillo-Hernandez B, Caballero-Hoyos R. [Association between neuropathy and peripheral vascular insufficiency in patients with diabetes mellitus type 2]. Rev Invest Clin 2011;63(6):621–9.

Valles-Antuna C, Fernandez-Gomez J, Fernandez-Gonzalez F. Peripheral neuropathy: an underdiagnosed cause of erectile dysfunction. BJU Int 2011;108(11):1855–9.

Kamenov ZA, Parapunova RA, Georgieva RT. Earlier development of diabetic neuropathy in men than in women with type 2 diabetes mellitus. Gend Med 2010;7(6):600–15.

Kamenov ZA. Comparison of the first intake of vardenafil and tadalafil in patients with diabetic neuropathy and diabetic erectile dysfunction. J Sex Med 2011;8(3):851–64.

Ravaglia S, Marchioni E, Costa A, Maurelli M, Moglia A. Erectile dysfunction as a sentinel symptom of cardiovascular autonomic neuropathy in heavy drinkers. J Peripher Nerv Sys 2004;9(4):209–14.

Grant PS, Lipscomb D. How often do we ask about erectile dysfunction in the diabetes review clinic? Development of a neuropathy screening tool. Acta Diabetol 2009;46(4):285–90.

Mehtiyev TV. [Stress, anxiety, depression and erectile dysfunction in patients with diabetes mellitus]. Georgian Med News 2013;(220-221):77–81.

Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I, Rodriguez-Vela L, Jimenez-Cruz JF, Burgos-Rodriguez R. Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study. J Urol 2001;166(2):569–74.

Tata S, Morewitz S, Tan KH, Clark J. Demographic characteristics of individuals with diabetes mellitus and peripheral neuropathy. J Am Podiatr Med Assoc 2013;103(5):355–60.

Debono M, Cachia E, Cassar A, Calleja N, Mallia M, Vassallo J. Is erectile dysfunction a sentinel symptom for cardiovascular autonomic neuropathy in patients with type 2 diabetes? Andrologia 2008;40(1):1–6.

Suder NC, Wukich DK. Prevalence of diabetic neuropathy in patients undergoing foot and ankle surgery. Foot Ankle Spec 2012;5(2):97–101.

Hasani N, Khosrawi S, Hashemipour M, Haghighatiyan M, Javdan Z, Taheri MH, et al. Prevalence and related risk-factors of peripheral neuropathy in children with insulin-dependent diabetes mellitus. J Res Med Sci 2013;18(2):132–6.

Liu QZ, Hu LQ. [Advances in etiology of diabetes mellitus and erectile dysfunction]. Zhonghua Nan ke Xue 2002;8(3):215–7.

Gregory JA, Jolivalt CG, Goor J, Mizisin AP, Calcutt NA. Hypertension-induced peripheral neuropathy and the combined effects of hypertension and diabetes on nerve structure and function in rats. Acta Neuropathol 2012;124(4):561–73.

Cho DY, Mold JW, Roberts M. Further investigation of the negative association between hypertension and peripheral neuropathy in the elderly: an Oklahoma Physicians Resource/Research Network (OKPRN) Study. J Am Board Fam Med 2006;19(3):240–50.