Recent trends in reported incidence of erectile dysfunction, hypogonadism, PDE5i and testosterone replacement therapy prescriptions in patients with Type 2 diabetes mellitus in a primary care setting
BAUS ePoster online library. Kirby M. Jun 24, 2019; 259524; P4-1 Disclosure(s): MK has received funding for research, conference attendance, lecturing and advice from the pharmaceutical industry including Astellas, Pfizer, Takeda, Bayer, MSD, BI, Lilly, GSK, AZ and Menarini. Editor PCCJ Also on several NHS advisory boards including the Prostate cancer Risk Management Programme, The Prostate Cancer advisory Group and The National Prostate Cancer Audit.
Michael Kirby
Michael Kirby
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Abstract
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BACKGROUND

Erectile dysfunction (ED) and testosterone deficiency (TD) are complications of Type 2 diabetes (T2DM), and predictors of cardiovascular disease. Guidelines recommend that men with T2DM are assessed/treated for ED/TD, which was included into the GP Quality and Outcomes Framework (QOF) from 2013-14.

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

Method
Population: Male cohort (≥ 18 years) with T2DM and contributing to UK GP electronic health records from 1999-2016. Adjusted incidence rate ratios (IRRs) were estimated using multivariate Poisson regression.

RESULTS

141,310 adult males (mean: 60 years) with T2DM were included. During follow-up, 62,698 (44%) had a recorded ED assessment, 25,198 (18%) an ED diagnosis and 21,069 (15%) received a phosophodiesterase-5 inhibitor (PDE5i). ED assessments increased from 7.6 per 1000 PYAR in 2012 (95% CI: 7.0-8.3) to 620 in 2013 (95% CI: 614-626) when included into QOF but dropped to 59.4 (95% CI: 56-63) in 2016. Compared with 2012, the adjusted incidence of recorded ED diagnoses and PDE5i prescriptions doubled in 2013 (IRR 2.0; 95% CI: 1.8-2.1) before falling to below pre-QoF levels in 2016 (IRR 0.89; 95% CI: 0.82-0.97). 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.

CONCLUSION

To improve GP diagnosis/management of ED/TD in T2DM patients, incorporation of guidelines into a GP framework and/or financial incentives plus education may be required.
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