Effects of Glycemic Control and Antidiabetic Therapies on Erectile Function in Men With Type 2 Diabetes: A Systematic Review

Resumen

Introduction: Erectile dysfunction is a common complication in men with type 2 diabetes mellitus and other metabolic disorders, with a multifactorial pathophysiology. The impact of glycemic control and antidiabetic therapies on erectile function remains controversial. Our objective was to evaluate the relationship between glycemic control, antidiabetic therapies, and erectile function in men with type 2 diabetes mellitus. Methods: A systematic review was conducted following PRISMA 2020 and Cochrane recommendations. Nine non-randomized clinical studies were included. Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated using GRADE. Results: Four cross-sectional studies, three prospective studies, and two retrospective cohort studies were included. The association between HbA1c and erectile function was heterogeneous and inconsistent across studies. GLP-1 receptor agonists showed favorable associations with improvements in erectile function and metabolic parameters, although the evidence was limited and of low to moderate certainty. Glycemic control may influence the response to phosphodiesterase type 5 inhibitors. Discussion: The findings suggest that erectile function in type 2 diabetes depends on multiple metabolic, vascular, and hormonal factors beyond isolated glycemic control. Conclusion: Clinically relevant associations are suggested, but the evidence is insufficient to establish causality. Prospective studies and randomized clinical trials are required.