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In the Massachusetts Male Aging Study (4), men with treated diabetes had a 28% age-adjusted prevalence of complete ED (no erections), almost three times higher than the prevalence of complete ED observed in the entire sample of men (10%).

Several studies have shown an increased risk of ED in men with diabetes; however, most information refers to the total male diabetic population, and few studies have presented data specifically for type 1 diabetes (5–8).

Although the prevalence of ED in the total diabetic population increases with age, smoking, and poor metabolic control, one study reported that men with elevated BMI and type 1 diabetes showed a significantly higher risk of ED than men with elevated BMI and type 2 diabetes (7).

The same study also showed that the age-adjusted prevalence of ED was higher in men with type 1 diabetes (51%) than with type 2 diabetes (37%). Although the etiology of ED in patients with diabetes is often complex and can be caused by several mechanisms, organic vasculogenic factors appear to be the most frequent cause of ED in men with female viagra tablet online shopping diabetes (9), with some studies citing an incidence of up to 87% (10).

Within vasculogenic ED, the most common etiology is arterial insufficiency, found more frequently in men with type 1 diabetes (73%) than with type 2 diabetes (61%) (11). Moreover, in men with type 1 diabetes, the severity of arterial insufficiency correlated with the presence of smoking, hypertension, and coronary artery disease, although only those with the latter disease showed a statistically significant reduction viagra sale without prescription in penile blood flow compared with men who had type 2 diabetes (11). Treatment options for men female viagra tablet online shopping with ED have advanced significantly during the past 10–15 years, and a number of approaches have been used for men with diabetes (12–14). However, efficacy and/or long-term satisfaction with most of these treatment options have been suboptimal. Sildenafil citrate (Viagra; Pfizer, New York) has in past studies demonstrated efficacy in men with diabetes (2,7,8,15,16); the aim of this study was to assess its efficacy exclusively in men with type 1 diabetes and ED. This was a double-blind, randomized, placebo-controlled, multicenter, parallel-group, flexible-dose study that included 188 patients with type 1 diabetes and ED.

Following a 4-week run-in period, during which baseline data on sexual function were collected, patients were randomized to sildenafil (50 mg) or matching placebo and entered a 12-week double-blind treatment period with follow-up visits after 2, 4, 8, and 12 weeks of treatment.

Dosage adjustments to 100 or 25 mg sildenafil or matching placebo were made according to efficacy and tolerability. This study included male patients of age 18 years or older with a clinical diagnosis of ED of more than 6 months’ duration and in a stable relationship with a female partner of more than 6 months’ duration. Patients had a clinical diagnosis of type 1 diabetes of at least 1 year’s duration as defined by the National Diabetes Data Group (17) and had required insulin within 1 month of diagnosis. Diabetes had to be generally stable for 6 months before study entry, with HbA 1c levels 66% of patients reported improved erections (compared with 29% in the placebo group), and the number of successful intercourse attempts with sildenafil (63%) was significantly higher compared with placebo (33%). These data are in agreement with an earlier study, where sildenafil was shown to be an effective and well-tolerated treatment in a group online cialis reddit of 268 men with ED and concomitant diabetes (type 1 and 2) (2). In this patient group, efficacy of sildenafil was independent of age, duration of ED, and duration of diabetes, and erections were improved in 56% of patients receiving sildenafil compared with 10% of female viagra tablet online shopping patients taking placebo.

Similarly, a recent study in 219 patients exclusively with type 2 diabetes demonstrated that sildenafil was well tolerated and effective in improving ED in this patient group (65% of patients reported improved erections compared with 11% in the placebo group), even in cases with poor glycemic control and chronic complications (16).

Thus, the current study demonstrated similar efficacy, although the improvement in the placebo group was larger.

It is well documented that in comparison with other disease-specific populations, the efficacy of sildenafil is lower in men with diabetes.

(19) reported improved erections in 77–88% of men with broad spectrum ED receiving sildenafil. Similarly, men with spinal cord injury (20) or depression (21) demonstrated high response rates to sildenafil (78 and 69%, respectively). The reason for poorer efficacy in the diabetic population is thought female viagra tablet online shopping to be the multifactorial nature of the disease.