The Diabetes Prevention Program Outcomes Study (DPPOS) followed 568 men with diabetes, pre-diabetes or metabolic syndrome (J Diabetes Complications, Dec 29, 2023;38(2):108669). Erectile dysfunction (ED), inability to achieve and maintain an erection, was reported by 37 percent of men with diabetes and 41 percent of those with pre-diabetes. The men were treated with:
• intensive lifestyle changes alone,
• metformin (a diabetes drug) alone, or
• a combination of intensive lifestyle changes and metformin.
Men in the metabolic syndrome and pre-diabetes groups had their ED improve with intensive lifestyle changes, but not with metformin alone. Men in the diabetes group did not have ED improvement with any of the treatments. This study shows that it is incredibly important for people with pre-diabetes or metabolic syndrome to be diagnosed and treated as early as possible to reduce their high blood sugar levels. Once they develop full-blown diabetes, they will be more likely to suffer ED and more resistant to treatment.

My Definitions of Metabolic Syndrome, Pre-Diabetes and Diabetes
Your doctor may give you a diagnosis of Metabolic Syndrome or Pre-Diabetes to let you know that your blood sugar after eating is too high and that you need treatment to avoid progressing to diabetes.

Metabolic Syndrome usually means that you have normal fasting blood sugar (below 100 mg/dL) but have three or more of the following:
• a large waistline, pinching more than 2.5 inches of fat and skin next to belly button,
• high triglycerides (more than 130 mg/dL),
• low good HDL cholesterol (less than 35 mg/dL). and
• high blood pressure (over 125/85).

Pre-Diabetes means you have a fasting blood sugar over 100 but under 126 mg/dL. You may also have the symptoms of Metabolic Syndrome and more than 145 mg/dL one hour after eating a meal.

Diabetes: You are likely to be diagnosed as Diabetic (Type II Diabetes) if you have fasting blood sugar over 125 mg/dL. Other signs of diabetes include:
• triglycerides over 150 mg/dL,
• blood sugar higher than 145 one hour after eating a meal,
• bad LDL cholesterol greater than 100 mg/dL,
• blood pressure greater than 130/90 mm Hg,
• having signs of a fatty liver.

Progression to Diabetes
I believe that the main reason for using these three terms is the progression that will give you plenty of warning. Metabolic syndrome is often treated just with lifestyle changes, while pre-diabetes can be treated just with lifestyle changes but is more commonly treated with drugs. Diabetes is almost always treated with drugs plus lifestyle changes. The dietary treatment and other lifestyle recommendations should be followed if you have any of these diagnoses.

Dietary Treatment for Metabolic Syndrome, Pre-Diabetes and Diabetes
• Eat lots of vegetables, but limit starchy root vegetables such as potatoes and sweet potatoes.
• Eat lots of legumes (beans, lentils, chickpeas, soybeans, peanuts) and nuts.
• Eat whole (unground) grains and restrict refined carbohydrates (usually foods made from flour: bakery products, pastas, most dry breakfast cereals).
• Restrict mammal meat and processed meats.
• Restrict salt.
• Eat seafood twice a week or more.
• Avoid sugar-sweetened and artificially sweetened beverages.
• Avoid sugar-added foods.

Other Recommended Lifestyle Changes
• Lose weight if overweight.
• Avoid smoke and smoking.
• Restrict alcohol.
• Check with your doctor about starting and maintaining a regular exercise program (Br J Spots Med, Jan 20, 2023).
• Include strength training in your exercise program. Strength training lowers high blood sugar levels and liver fat, even before weight loss occurs (Journal of Endocrinology, Apr 2019;241(1):59-70).
• Keep blood levels of hydroxy vitamin D above 30 nmol/L.