Predictors of Dual Phosphodiesterase Type 5 Inhibitor Therapy in Persons With Erectile Dysfunction and Diabetes
Abstract
Background While on-demand phosphodiesterase type 5 inhibitors (PDE5i) remain standard therapy for erectile dysfunction (ED), data are lacking for non-responders, particularly those with diabetes, who require dual phosphodiesterase type 5 inhibitor therapy (DPT), i.e, daily low-dose tadalafil and on-demand PDE5i. This represents one of the first studies addressing this critical gap in evidence. Aim To identify the predictors of requirement for dual PDE5i therapy in persons with type 2 diabetes and ED. Methods A retrospective study conducted at a diabetes center in Lucknow, India (November 2020-October 2022), involving a total of 5,243 visits by persons with type 2 diabetes, of which 517 were ED-related visits (n=276). After exclusions, 196 on-demand PDE5i users were included, and 72 non-responders received DPT. Predictors were assessed via multivariate logistic regression. Obesity was defined as body mass index (BMI) ≥25 kg/m² (as per Indian guidelines). Outcomes The primary outcome was the need for DPT, defined by on-demand failure. Results Individuals requiring DPT were older (53 vs. 49 years, p=0.012), had higher creatinine (0.94 vs. 0.9 mg/dL, p=0.033), and had longer diabetes duration (11 vs. 8 years, p=0.005). A significantly higher proportion of individuals with elevated hemoglobin A1c (HbA1c) (p=0.016), increased creatinine levels (p=0.007), and the presence of obesity (p=0.0047) required substantial DPT. Optimal cutoffs were age ≥50, HbA1c ≥8.1%, and creatinine…
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