Brampton, Ontario—Erectile dysfunction among men is one of the most dreaded side effects of longer-term type 2 diabetes (T2D).

Whether the choice of therapy could make a difference has remained unclear. So, for example, even though diabetes is a major risk factor for erectile dysfunction, the effect of GLP-1 receptor agonists on erectile dysfunction was essentially unknown.

An international study led by Canadian researchers sought to remedy that by assessing the incidence, prevalence, and progression of erectile dysfunction in men treated with dulaglutide compared with placebo. The report, published in the Lancet Diabetes & Endocrinology, notes that the study team also wanted to determine whether dulaglutide’s effect on erectile dysfunction was consistent with its effect on other diabetes-related outcomes.

Data were from The Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) study, a double-blind, placebo-controlled, randomized trial of the effect of dulaglutide on cardiovascular outcomes. REWIND involved 371 sites in 24 countries.

Participants included men and women aged more than 50 years with T2D who had either a previous cardiovascular event or cardiovascular risk factors; the patients were randomly assigned (1:1) to receive either dulaglutide or placebo.

In addition, male participants were offered the opportunity to complete the standardized International Index of Erectile Function (IIEF) questionnaire at baseline, 2 years, 5 years, and study end.

For their review, the authors included participants who completed a baseline and at least 1 follow-up IIEF questionnaire. Defined as the primary outcome for the analyses was the first occurrence of moderate or severe erectile dysfunction following randomization, assessed by the erectile function subscores on IIEF.

Results indicate that between August 18, 2011, and August 14, 2013, 70.1% of 5,312 male participants with a mean age of 65.5 years were analyzed. The study team determined that 39.9% of them had a history of cardiovascular disease, and 56.5% had moderate or severe erectile dysfunction at baseline.

The study adds that the incidence of erectile dysfunction following randomization was 21.3 per 100 person-years in the dulaglutide group and 22.0 per 100 person-years in the placebo group (HR, 0·92; 95% CI, 0·85-0·99, P = .021). The authors point out that men in the dulaglutide group also had a less steep fall in erectile function subscore compared with the placebo group, with a least-square mean difference of 0·61 (95% CI, 0.18-1·05, P = .006).

“Long-term use of dulaglutide might reduce the incidence of moderate or severe erectile dysfunction in men with type 2 diabetes,” the authors suggest.

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