Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study

Shazli Azmi, Maryam Ferdousi, Uazman Alam, Ioannis N. Petropoulos, Georgios Ponirakis, Andrew Marshall, Omar Asghar, Hassan Fadavi, Wendy Jones, Mitra Tavakoli, Andrew J.M. Boulton, Maria Jeziorska, Handrean Soran, Nathan Efron, Rayaz A. Malik

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7 Citations (Scopus)

Abstract

Aims/hypothesis: The aim of this study was to identify the contribution of small- and large-fibre neuropathy to erectile dysfunction in men with type 1 diabetes mellitus. Methods: A total of 70 participants (29 without and 41 with erectile dysfunction) with type 1 diabetes and 34 age-matched control participants underwent a comprehensive assessment of large- and small-fibre neuropathy. Results: The prevalence of erectile dysfunction in participants with type 1 diabetes was 58.6%. After adjusting for age, participants with type 1 diabetes and erectile dysfunction had a significantly higher score on the Neuropathy Symptom Profile (mean ± SEM 5.3 ± 0.9 vs 1.8 ± 1.2, p = 0.03), a higher vibration perception threshold (18.3 ± 1.9 vs 10.7 ± 2.4 V, p = 0.02), and a lower sural nerve amplitude (5.0 ± 1.1 vs 11.7 ± 1.5 mV, p = 0.002), peroneal nerve amplitude (2.1 ± 0.4 vs 4.7 ± 0.5 mV, p < 0.001) and peroneal nerve conduction velocity (34.8 ± 1.5 vs 41.9 ± 2.0 m/s, p = 0.01) compared with those without erectile dysfunction. There was also evidence of a marked small-fibre neuropathy with an impaired cold threshold (19.7 ± 1.4°C vs 27.3 ± 1.8°C, p = 0.003), warm threshold (42.9 ± 0.8°C vs 39.0 ± 0.9°C, p = 0.005) and heart rate variability (21.5 ± 3.1 vs 30.0 ± 3.7 beats/min, p = 0.001) and reduced intraepidermal nerve fibre density (2.8 ± 0.7 vs 5.9 ± 0.7/mm, p = 0.008), corneal nerve fibre density (12.6 ± 1.5 vs 23.9 ± 2.0/mm2, p < 0.001), corneal nerve branch density (12.7 ± 2.5 vs 31.6 ± 3.3/mm2, p < 0.001) and corneal nerve fibre length (8.3 ± 0.7 vs 14.5 ± 1.0 mm/mm2, p < 0.001) in participants with type 1 diabetes and erectile dysfunction. Erectile dysfunction correlated significantly with measures of both large- and small-fibre neuropathy. Conclusions/interpretation: Small-fibre neuropathy is prominent in patients with type 1 diabetes, and is associated with erectile dysfunction and can be objectively quantified using corneal confocal microscopy. This may allow the identification of patients who are less likely to respond to conventional therapies such as phosphodiesterase type 5 inhibitors.

Original languageEnglish
Pages (from-to)1094-1101
Number of pages8
JournalDiabetologia
Volume60
Issue number6
DOIs
Publication statusPublished - 1 Jun 2017

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Keywords

  • Corneal confocal microscopy
  • Erectile dysfunction
  • Neuropathy
  • Small-fibre neuropathy
  • Type 1 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Azmi, S., Ferdousi, M., Alam, U., Petropoulos, I. N., Ponirakis, G., Marshall, A., Asghar, O., Fadavi, H., Jones, W., Tavakoli, M., Boulton, A. J. M., Jeziorska, M., Soran, H., Efron, N., & Malik, R. A. (2017). Small-fibre neuropathy in men with type 1 diabetes and erectile dysfunction: a cross-sectional study. Diabetologia, 60(6), 1094-1101. https://doi.org/10.1007/s00125-017-4245-z