Endocrine Abstracts

Background: Erectile dysfunction affects nearly half of men with type 2 diabetes (T2DM), and one-third of diabetic men have hypogonadism¹. As an add-on to TRT in hypogonadal men with T2DM, Liraglutide may improve erectile function², and dulaglutide decreased the incidence of moderate and severe ED in T2DM³.

Study aims: To assess the GLP-1RA effect in T2DM men complaining of ED treated with both liraglutide and dulaglutide as an add-on to metformin.

Design overview: This was a 1-year retrospective observational study. Patients with established type 2 diabetes mellitus, serum HbA1c < 8.5%, two or more additional cardiovascular risk factors were included. Men with estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m² were excluded. As per protocol, men with HbA_1c <7.2 % received metformin (2000 mg per day) while those with serum HbA1c >7.2% received a GLP-1RA as in add-on to metformin (52% liraglutide, 1.2 mg/day; 48% dulaglutide, 1.5 mg/week) for one year. ED was diagnosed and classified by the International Index of Erectile Function 5 (IIEF5) score. Hypogonadal men were identified according to standardized parameters from the European Male Aging Study (EMAS).

Results: Forty-eight men with hypogonadism (HP) and 62 eugonadal individuals (EP) complaining of ED were retrospectively eligible for analyses. Mean age ranged 51–64 years; T2DM evolution ranged from 5–10 years. Around 6% of participants had established cardiovascular disease. Twenty-eight HP were on metformin plus a GPL-1RA (HPs), and 20 HP were on metformin alone (HPc); thirty-eight EP received metformin plus a GPL-1RA (EPs), and 30 were on metformin alone (EPc). After 12 months of treatment, both HPs and EPs significantly reduced serum HbA_1c compared to baseline (-0.7 ± 0.3 %; P<0.001). HPc and EPc slightly increased HbA_1c (0.4 ± 0.2). IIEF 5 score increased from baseline (all P<0.01) in HPs and EPs.

Conclsione: Liraglutide and dulaglutide seem to have a favorable effect on ED in T2DM men with and without baseline hypogonadism. Further controlled studies are needed to confirm those preliminary results.

References: 1. Kouidrat Y et al., Diabet Med. 2017, 34(9), 1185–92.

2. Giagulli VA, et al., Andrology. 2015, 3(6), 1094–103.

3. Bajaj HS et al., Lancet Diabetes Endocrinol. 2021, 9(8), 484–90