Endocrine Abstracts

JOINT24

Background: Erectile dysfunction (ED), a condition impacting quality of life, is increasingly linked to insulin resistance (IR). This study aims to evaluate the relationship between IR indices and the incidence and severity of ED, providing insights into their diagnostic and predictive utility in practice.

Methods: A comprehensive search across PubMed, Embase, Web of Science, and Scopus was carried out. Required data were extracted and meta-analyzed. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the studies’ risk of bias. Sensitivity analyses and meta-regressions were conducted to explore heterogeneity and the impact of confounding variables.

Results: Seventeen studies with a total of 3810 patients with ED and 8252 without ED were included. Meta-analysis revealed that males with ED had significantly higher levels of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (SMD = 0.59, 95% CI [0.15, 1.03], I2 = 82%, P < 0.01), Triglyceride-Glucose Index (TyG) (SMD = 0.53, 95% CI [0.31, 0.75], I2 = 69%, P < 0.01), and Visceral Adiposity Index (VAI) (SMD = 0.45, 95% CI [0.25, 0.64], I2 = 76%, P < 0.01) compared to those without ED. However, there was no significant correlation between a one-unit increase in HOMA-IR (OR = 0.63, 95% CI [0.03, 13.69], I2 = 91%, P = 0.77) or TyG (OR = 0.53, 95% CI [0.02, 11.53], I2 = 88%, P = 0.68) and the odds of ED. Additionally, a one-unit increase in VAI was associated with more severe ED (SMD = 0.34, 95% CI [0.03, 0.64], I2 = 16%, P = 0.03). The diagnostic accuracy of these indices varied.

Conclusions: The results indicate a significant connection between insulin resistance and erectile dysfunction, as shown by HOMA-IR, TyG, and VAI. These indices highlight the potential role of metabolic dysfunction in the pathophysiology of ED, suggesting that IR may contribute to endothelial dysfunction and vascular impairment. Clinically, it is important to assess IR in men with ED, particularly in those with comorbid cardiometabolic conditions. Given the observed association between VAI and ED severity, targeting visceral adiposity through lifestyle modifications, weight management, and pharmacological treatments aimed at improving insulin sensitivity may concurrently alleviate ED progression. Future research should focus on standardizing IR assessment methods and exploring integrated diagnostic models that combine IR indices with other biomarkers to enhance predictive accuracy and clinical applicability. This approach could pave the way for personalized treatment strategies, ultimately improving both metabolic and sexual health outcomes in affected individuals.