Background
Erectile dysfunction(ED) is an important complication of diabetes that’s associated with multiple comorbidities. The pathogenesis of ED in men with DM is multi factorial including vascular, neurologic, metabolic endocrinologic, psychologic, hormonal and lifestyle factors. The presence of ED is associated with microangiopathy, increased risk of cardiovascular disease and depression. In addition to these negative associations of ED, it also affects all aspects of a man’s life resulting in reduced quality of life. Despite ED in DM being largely treatable majority of the cases remain undiagnosed and untreated. The true burden of ED among men with DM in Kenya has not been determined yet.
Aim
This study was carried out to determine the prevalence and factors associated with ED among men attending a diabetes clinic in a referral hospital in western Kenya.  
Method
All men above 18 years of age in stable sexual relationships were included in the study. Demographic information was collected using an interviewer administered questionnaire. Presence of ED was assessed using the IIEF-5 questionnaire after which the PHQ-2 questionnaire was administered to assess for presence of depression. Blood samples were drawn for measurement of HbA1c, morning testosterone levels, fasting lipid levels and creatinine levels. Eye examination including fundoscopy was done by an ophthalmologist. Additional measurements taken included blood pressure, ankle brachial index, BMI, and 9 gram mono filament test. Data analysis was done using R (R Core Team, 2016) software for statistical computation.
Results
ED was highly prevalent at76.7% majority (32.4%) having mild to moderate ED. The prevalence of ED increased with increase in age with 93.2% men aged over 60 years having ED. The comorbidities associated with presence of ED were hypertension (OR 2.37, P= 0.005) and depression (OR 2.18, p<0.0001). There was no association with presence of peripheral vascular disease. Demographic and clinical factors associated with ED included age (p<0.0001), duration of diabetes above 10 years (p= 0.015) and use of high dose of a thiazide diuretic (p=0.003). There was no association between presence of ED and recent glycemic control, cigarette use, alcohol use, low levels of testosterone or BMI. Presence of ED was associated with the presence of other DM complications such as diabetes retinopathy (OR 2.7, p=0.013) and kidney injury (OR 2.16, p=0.06). There was no association between the presence of ED and that of diabetes macula oedema and peripheral neuropathy
Conclusion
ED is highly prevalent among men with DM attending clinic in MTRH and screening for it should be incorporated into routine care. It is associated with depression, hypertension and use of thiazide diuretics. Management of these conditions and judicious use of thiazide diuretics in this population may help reduce ED prevalence and improve their quality of life. Men with ED should be screened for other DM associated complications such as diabetes retinopathy and kidney injury given the strong association noted.

Prevalence and factors associated with erectile dysfunction among men with diabetes at Moi Teaching Referral Hospital