The sglt2 inhibitor dapagliflozin improves erectile dysfunction in patients with type 2 diabetes mellitus: a prospective study

Erectile dysfunction (ED) is a condition affecting 150 million men worldwide. Its prevalence is higher among diabetic patients, in whom it is directly related to the number and severity of complications and comorbidities. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new category of antidiabetic drugs that have been shown to improve cardiovascular, renal, and neurological outcomes of patients with type 2 diabetes mellitus (T2DM). Empagliflozin, a member of this class of drugs, appears to improve erectile function in rats, while dapagliflozin effects on ED have not yet been studied. Therefore, this study aimed to evaluate the effects of dapagliflozin alone or in combination with tadalafil on ED in patients with T2DM. This was a prospective non-randomized study involving 30 Caucasian male patients with T2DM and severe ED, who were referred to the Division of Endocrinology, Metabolic Diseases and Nutrition, University of Catania (Catania, Italy). They were equally divided into three groups, assigned to treatment with tadalafil 5 mg/day (Group 1), tadalafil 5 mg/day plus dapagliflozin 10 mg/day (Group 2), and dapagliflozin 10 mg/day (Group 3) for three months. The presence and the severity of ED were evaluated at enrolment and after treatment, both by the International Index of Erectile Function 5-item (IIEF-5) questionnaire and by penile echo-color Doppler ultrasound (PCDU) examination after intracavernous injection of alprostadil. At the end of treatment, the three groups showed a significant improvement in IIEF-5 score, with the greatest effect observed in Group 2, where the combination of tadalafil plus dapagliflozin increased the IIEF-5 score approximately three-fold compared to enrollment. PCDU evaluation showed a significant increase in peak systolic velocity in all groups; however, the largest increase was observed in Group 2. Acceleration time was significantly shortened in Groups 1 and 2, with the highest extent achieved by Group 2. Finally, no significant difference was found in end-diastolic velocity after treatment. Dapagliflozin treatment improves ED in patients with T2DM and also enhances the efficacy of tadalafil. These clinical effects are associated with an improvement in cavernous artery vascularity demonstrated by the PDCU examination. Further studies are needed to confirm our results and explain the mechanism(s) by which dapagliflozin exerts its effect on ED.