Trends in reported incidence of erectile dysfunction, hypogonadism, PDE5i prescriptions and TRT in patients with type 2 diabetes in primary care

Background Erectile dysfunction (ED) and testosterone deficiency (TD) are complications of type 2 diabetes mellitus (T2DM), and predictors of cardiovascular disease. Guidelines recommend that men with T2DM are assessed and treated for ED/TD, which was included into the Quality and Outcomes Framework (QOF) from 2013–2014 only.

Aim Explore the effects of QOF on ED/TD diagnoses and management in T2DM patients.

Method The study population included males (≥18 years) with T2DM and contributing to UK GP electronic health records from 1999–2016. Adjusted incidence rate ratios (IRRs) were estimated using multivariable Poisson regression.

Results In total 135 342 adult males (mean age 60 years) with T2DM were included. During follow-up, 60 819 (45%) had a recorded ED assessment, 23 834 (18%) an ED diagnosis and of these 73% received a phosophodiesterase-5 inhibitor (PDE5i). ED assessments increased from 7.6 per 1000 PYAR in 2012 (95% confidence interval [CI] = 7.0 to 8.3) to 620 in 2013 (95% CI = 614 to 626) when included into QOF but dropped to 59.4 (95% CI = 56 to 63) in 2016. Compared with 2012, the adjusted incidence of recorded ED diagnoses and PDE5i prescriptions doubled in 2013 (incidence rate ratio [IRR] 2.0; 95% CI = 1.8 to 2.1) before falling to below pre-QOF levels in 2016 (IRR 0.89; 95% CI = 0.82 to 0.97). Of 1187 diabetic men diagnosed with ED or receiving a PDE5i in 2015, 213 (18%) had minimum one testosterone measurement, of which 45 (21%) met criteria for hypogonadism (testosterone ≤8nmol/l). Nine (20%) subsequently received testosterone replacement therapy (TRT).

Conclusion To improve diagnosis and management of ED/TD in T2DM patients and thereby (cardiovascular) health and quality of life, incorporation of guidelines into a GP framework and/or financial incentives may be required alongside GP education.