Endocrine Abstracts

Introduction: Type 2 diabetes mellitus (T2DM) is associated with urological and endocrine complications, including erectile dysfunction (ED) and hypogonadism.

Aim: REVITALISE was conducted to assess men with/without T2DM at risk of ED and/or hypogonadism, and highlight gaps in current clinical management.

Methods: Data were collected from 13 UK primary care practices on incidence of ED, hypogonadism (defined as serum total testosterone <12 nmol/l), and use of phosphodiesterase type 5 inhibitors (PDE5i) and testosterone replacement therapy (TRT) in men with/without T2DM. Cardiovascular risk was assessed using the QRISK2 algorithm.

Results: Of 43 633 male patients analysed, 3185 had T2DM; prevalence 7.3%. 33.5% of men with T2DM were not asked about erection problems, which were more common in this group (19.7%) than in men without this condition (1.2%). 78.0% of men with T2DM and ED were not using PDE5i.

Data on testosterone levels during the 24 months preceding REVITALISE were available for 32.4%/39.8% of men with ED with/without T2DM, respectively. Among patients with T2DM and ED, 67.6% had not had a testosterone test (of whom 13.7% had QRISK2 score >10); 72.8% of those with testosterone levels <12 nmol/l did not receive TRT. Among patients with T2DM who had a testosterone test, 68.4% with testosterone levels ≤8 nmol/l (considered the cut-off value for low testosterone) were not receiving TRT, of whom 7.7% had QRISK2 score >20. Similarly, 76.7% of patients with testosterone levels >8 and ≤12 nmol/l did not receive TRT, of whom 9.1% had QRISK2 score >10. Among patients without T2DM, 23.1% had hypogonadism, of whom 42.6% were receiving TRT.

Conclusions: In REVITALISE, a substantial number of men with T2DM were not assessed for ED and/or hypogonadism, losing a valuable opportunity to improve their overall health and quality of life. Where diagnosed, management was suboptimal and often did not follow current UK guidelines.