1. Canadian Diabetes Association Clinical Practice Guidelines Erectile Dysfunction Chapter 33 Gerald Brock, William Harper

2. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Erectile Dysfunction (ED) Checklist SCREEN all adult men regularly with sexual function history INVESTIGATE for hypogonadism if ED present TREAT erectile dysfunction with PDE-5 inhibitor as first-line therapy (if no contraindication) 2013

3. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association ED affects 34-45% of men with DM 40% of men over 60 years with DM have complete ED ED negatively impacts quality of life Common + Important Screen all adult men with DM regularly as part of sexual function history Screen for ED

4. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Screen all men with DM for ED Screen for hypogonadism (Testosterone level) PDE-5 inhibitors 2 Urology Referral Consider Testosterone replacement 3 PDE-5 inhibitor Modify risk factors 1 PresentNone NormalLow Contraindication or ED persists ED Present 1 Risk factors: glycemic control, cigarette smoking, HTN, dyslipidemia and androgen deficiency states. 2 If there are no contraindications (ie: active CAD, nitrates) 3 If there are no contraindications (ie: no pre-existing prostate cancer (PC)), if the patient still desires fertility consult a specialist before prescribing testosterone. Note: Patient has to be followed for side effects PDE5: Phosphodiesterase 5 inhibitors 2013

5. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association 1.All adult men with diabetes should be regularly screened for ED with a sexual function history [Grade D, Consensus] 2.Men with diabetes and ED should be investigated for hypogonadism [Grade D, Level 4] 3.A PDE5 inhibitor, if there are no contraindications to its use, should be offered as first-line therapy to men with diabetes and ED either on-demand [Grade A, Level 1A] or scheduled-use dosing regimen [Grade B, Level 2] 2013 Recommendations 1, 2 and 3

6. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association 4.Referral to a specialist in ED should be considered for eugonadal men who do not respond to PDE5 inhibitors or for whom the use of PDE5 inhibitors is contraindicated [Grade D, Consensus] 5.Men with diabetes and ejaculatory dysfunction who are interested in fertility should be referred to a healthcare professional experienced in the treatment of ejaculatory dysfunction [Grade D, Consensus] Recommendations 4 and 5

7. guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association CDA Clinical Practice Guidelines http://guidelines.diabetes.cahttp://guidelines.diabetes.ca – for professionals 1-800-BANTING (226-8464) http://diabetes.ca http://diabetes.ca – for patients