We compared the efficacy and safety between once?daily dosing and on?demand use of udenafil for type 2 diabetic patients with erectile dysfunction (ED). A multi?center, randomized, open?label, parallel?group, 12?week study was conducted. 161 patients who improved with on?demand 200 mg of udenafil according to Sexual Encounter Profile (SEP) diary Question 2 and 3 (Q2 and Q3) were randomized into 200 mg on?demand (n = 80) or 50 mg once?daily (n = 81) dosing groups for 8 weeks. The dosing period was followed by a 4?week treatment?free period. The primary efficacy endpoint was the change of the International Index of Erectile Function (IIEF) erectile function domain (EFD) score. The secondary efficacy endpoints included changes to the SEP diary Q2, Q3, IIEF Q3, Q4, other domains of IIEF, Global Assessment Question, and shift to the normal rate (EFD ≥ 26). Vascular endothelial markers were also assessed. The IIEF?EFD score of both groups improved after 8 weeks of treatment (P < 0.0001). There was no statistically significant difference between two groups. Improvement was not maintained after the treatment?free follow?up period. Similar results were observed in the secondary efficacy endpoints. There was also no significant difference in vascular endothelial markers. Daily udenafil was well?tolerated, and there was no significant difference in the adverse drug reactions and adverse events between the two groups. Flushing and headache were the most frequent adverse events. Both regimens improved ED in diabetic patients and were well?tolerated. Further studies are needed to assess the effect of daily udenafil treatment in diabetic patients.