Association between comorbidity and erectile dysfunction in patients with diabetes.

The aims of this study were to determine the prevalence of erectile dysfunction (ED) and its relationship with comorbidity in patients with diabetes. The study population comprised of 312 consecutive patients aged 20 years or over residing in the city of Hamadan in Iran in 2005. Depression was assessed by the modified version of the Beck Depression Inventory (BDI-II) and ED by the short form of the International Index of Erectile Function (IIEF-5) questionnaire. Potential confounding was controlled by stratification and by a logistic regression model. The prevalence of moderate or complete ED (IIEF score <or=11) was 34% and that of moderate or severe depressive symptoms 30%. Each 1-year increment in diabetes duration was associated with a 10% higher risk of ED. The risk of ED was higher in men with depression (odds ratio (OR)=10.7, 95% CI 5.4-21.1) and in those with cardiovascular disease (CVD) (OR=2.0, 95% CI 1.1-3.6). CVD was associated with ED only in elderly men, whereas depression was related to ED in both young and older subjects. The risk of ED was higher in subjects with both depression and CVD (OR=17.2, 95% CI 6.8-43.1 compared with men free from both diseases). Subjects who consumed fruits weekly or seldom had a higher risk of ED (OR=3.2) compared with those who consumed daily. Our study shows a strong association between depressive symptoms and ED. The association is much stronger for older men. Depression and CVD may interact with one another in relation to a higher risk of ED. A diet rich in fruits may have a beneficial effect on erectile function.