A study to evaluate the prevalence of hypogonadism in Indian males with Type-2 diabetes mellitus

Agarwal, Pankaj; Singh, Parminder; Chowdhury, Subhankar; Sharma, Sarit; Majumdar, Anirban; Shah, P.N.; Sahay, Rakesh; Ayyar, S Vageesh; Phatale, Hemant; Batra, Chandar M; Syed, Raeesuddin; Ps, Shetty

doi:10.4103/2230-8210.196008

Cited by 28 publications

(13 citation statements)

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“…[4,17] Similarly high prevalences have also been reported from India (26.3%), Jordan (36.5%) and Poland (46%). [18][19][20] Furthermore, the observation of significantly lower TT and FT in the diabetic men compared with the control subjects is compatible with the findings of a large meta-analysis. [5]…”

Section: Discussionsupporting

confidence: 88%

Prevalence of low serum testosterone levels among men with type 2 diabetes mellitus attending two outpatient diabetes clinics in KwaZulu-Natal Province, South Africa

et al. 2019

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Corresponding author: I M Paruk (paruki@ukzn.ac.za) Background. The reported prevalence of low testosterone among men with type 2 diabetes mellitus (T2DM) is high. However, there is a dearth of information on the prevalence of androgen deficiency symptoms and low serum testosterone levels in men with T2DM from sub-Saharan Africa. Scanty data are available from Nigeria, Ghana and South Africa (SA). Objectives. To determine the prevalence of low serum testosterone and associated risk factors and the prevalence of androgen deficiency symptoms in men with T2DM. Methods. In a cross-sectional observational study, androgen deficiency symptoms in men with T2DM attending two outpatient diabetes clinics in Durban, KwaZulu-Natal Province, SA, were assessed using the Ageing Males' Symptoms Scale (AMS) questionnaire and direct enquiry. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), luteinising hormone (LH), fructosamine, serum lipids and glycated haemoglobin (HbA1c) were measured and free testosterone (FT) was calculated. TT, SHBG and FT levels were measured in control subjects with no history of diabetes. Results. There were 148 men with T2DM in the study group and 50 control subjects in the control group. In the study group, the majority were black Africans (58.8%); Indians (39.2%) and whites (2.0%) constituted the remainder. The mean (standard deviation (SD)) age was 57.5 (11.2) years, the mean duration of diabetes 11.4 (8.9) years and the mean HbA1c 8.6% (1.9%). Of the study group, 85.8% had metabolic syndrome. Mean TT, SHBG and FT and median LH (interquartile range) in the study group were within normal ranges. However, mean (SD) serum TT and FT were lower in the study group than in the control subjects (14.5 (5.8) v. 18.8 (7.2) nmol/L; p<0. 001 and 265.9 (90.4) v. 351.7 (127.3) pmol/L; p<0.001, respectively). The prevalence of low serum total testosterone (LSTT) and low serum free testosterone (LSFT) in the study group was 35.8% and 16.2%, respectively. The prevalence of androgen deficiency symptoms using the AMS questionnaire was 74.5% and correlated poorly with LSTT or LSFT. In multivariate analysis, LSFT was significantly associated with age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.02 -1.218; p=0.043) and waist circumference (WC) (OR 1.033, 95% CI 0.999 -1.068; p=0.059). LSTT was associated with body mass index (BMI) only (OR 1.138, 95% CI 1.063 -1.218; p<0.0001). TT correlated inversely with BMI, WC and the number of metabolic syndrome criteria. FT correlated inversely with BMI, WC and WHR. Conclusions. There was a high prevalence of LSTT, LSFT and androgen deficiency symptoms in this study. Serum TT and FT were lower in men with T2DM than in control subjects. Risk factors associated with LSFT or LSTT included higher BMI and WC and older age. The AMS score was a poor predictor of low testosterone. More research is required locally before any screening policy can be recommended. S Afr Med J 2019;109(12):963-970. https://doi.

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Section: Discussionsupporting

confidence: 88%

Prevalence of low serum testosterone levels among men with type 2 diabetes mellitus attending two outpatient diabetes clinics in KwaZulu-Natal Province, South Africa

et al. 2019

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“…Уровень тестостерона у пожилых мужчин снижается, и это снижение может обуславливать возникновение СД2, который в основном отмечается также в пожилом возрасте [5,6]. При этом уровни тестостерона у лиц с СД2 ниже таковых у здоровых мужчин в среднем на 2,5 нмоль/л, а распространенность гипогонадизма при СД2 выше, чем у лиц без диабета, и, по данным разных авторов, она может составлять более половины случаев [7,8,9]. Гипогонадизм у больных СД2 в подавляющем большинстве случаев проявляется после завершения периода полового развития, поэтому основными его клиническими проявлениями являются: половая дисфункция, увеличение грудных желез, снижение настроения, слабость и дисфория, бессонница, снижение жизненного тонуса, уменьшение мышечной силы и выносливости, висцеральное ожирение; при этом распространенность этих симптомов вариабельна [1,10].…”

Section: Abstract: Hypogonadism; Men; Testosterone Deficiency; Testosunclassified

The clinical and epidemiological characteristics of hypogonadism in men with type 2 diabetes mellitus

Мельниченко¹,

Shestakova²,

Роживанов³

2020

Diabetes mellitus

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BACKGROUND: Male hypogonadism is a frequent complication of diabetes mellitus (DM) type 2; therefore, a study of its clinical and epidemiological characteristics is of interest. AIMS: Assessment of clinical and epidemiological characteristics of hypogonadism in men with diabetes mellitus type 2. METHODS: A full-design, cross-sectional, screening, multicenter, non-interventional study included men with diabetes mellitus type 2. The study was conducted from November 2017 to January 2019.Medical history assessment, sexological testing, estimation of luteinizing hormone (LH), sex hormone-binding globulin; total testosterone and glycated hemoglobin were performed. Free testosterone was calculated by the Vermeullen method. Comparison of groups was carried out using Yatess corrected version of chi-squared test, Mann-Whitney U-test, and Spearmans rank correlation method was also used. Differences were considered statistically significant with p 0,05. RESULTS: The age of 554 men included in the study was 55 [50; 58] years, total testosterone level was 12,5 [9,1; 16,4] nmol/L; free testosterone was 0,266 [0,205; 0,333] nmol/L; HbA1c 7,2 [6,2; 8,9] %. Hypogonadism syndrome was detected in 181 men (32,7%). Total testosterone level in these patients was 7,8 [6,5; 9,4] nmol/L, and free testosterone level was 0,182 [0,152; 0,217] nmol/L. In patients without hypogonadism, these parameters were 14,7 [12,4; 18,0] nmol/L and 0,308 [0,265; 0,362] nmol/L, respectively. In most cases, patients with hypogonadism had normal, but lower LH levels of 3,3 [2,2; 4,9] U/L compared with patients without hypogonadism 3,8 [2,7; 4,9], p = 0,022. Most often, normogonadotropic hypogonadism was detected (89,5%). Statistically significant negative correlations were found between total testosterone levels and body mass index (r = -0,24; p 0,001), and waist circumference (r = -0,21; p0,001). The prevalence of decreased libido in patients with hypogonadism (66,8%) is statistically significantly higher than that in men without hypogonadism (56,3%, p = 0,022). CONCLUSIONS: The prevalence of hypogonadism syndrome in men with diabetes mellitus type 2 is 32,7%. This type of hypogonadism is characterized by normal LH values.

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“…Для мужчин с СД характерно развитие смешанного гипогонадизма, при котором механизмам нарушения отрицательной обратной связи сопутствуют компо-ненты первичного (уменьшение числа клеток Лейдига и их чувствительности к гонадотропинам, ишемиче-ские тестикулярные изменения), а также вторичного (уменьшение выброса лютеинизирующего гормона (ЛГ), увеличение активности ароматазы) гипогона-дизма [10]. Безусловно, при СД могут встречаться и «классические» типы гипергонадотропного, гипого-надотропного гипогонадизма, а также резистентность андрогенных рецепторов [9]. Эти состояния подробно рассмотрены в рекомендациях по диагностике и лече-нию синдрома гипогонадизма у мужчин [8,11].…”

Section: этиологияunclassified

Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

et al. 2017

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Гипогонадизм у мужчин, определяемый как снижение уровня тестостерона в сыворотке крови в сочетании с характерными симптомами и/или признаками (подробно описаны далее), часто встречается при сахарном диабете (СД). Эти рекомендации не охватывают всего диапазона патологий, обусловливающих развитие дефицита тестостерона (гипогонадизма), а фокусиру-ются на его клинических вариантах, характерных для мужчин с диабетом. В рекомендациях представлены данные о распро-страненности гипогонадизма при СД, его этиологии. В разделе «диагностика» подробно представлены особенности анамнеза пациентов с гипогонадизмом при СД, необходимые методы физикального и лабораторного обследования. Отдельно рассмо-трены факторы риска и клинические последствия гипогонадизма. В разделе «выбор методов лечения» представлены возмож-ные варианты лечения таких пациентов с использованием различных средств андрогенной терапии с учетом потребностей мужчины, сохранения его репродуктивной функции и факторов риска. Особое внимание уделено показаниям, противопо-казаниям и факторам риска андрогенной терапии у мужчин с диабетом, особенно в пожилом возрасте. С учетом этого раз-работаны принципы мониторинга проводимого лечения. На основании большого числа исследований продемонстрированы благоприятные эффекты андрогенной заместительной терапии у мужчин с гипогонадизмом и СД. Ключевые слова: гипогонадизм, мужчины, дефицит тестостерона, тестостерон, сахарный диабет, метаболический синдром. Hypogonadism in men, defined as a reduction in serum testosterone in combination with characteristic symptoms and/or signs (described in detail later), is common in diabetes mellitus (DM). These recommendations do not cover the whole range of pathologies that cause the development of testosterone deficiency (hypogonadism), but focus on its clinical variants and characteristic for men with diabetes. The recommendations provide data on the prevalence of hypogonadism in diabetes, its etiology. In the section "diagnostics" the features of anamnesis of patients with hypogonadism with diabetes, the necessary methods of physical and laboratory examination are presented in detail. The risk factors and clinical consequences of hypogonadism are separately examined. In the section "choice of treatment methods", there are possible treatment options for such patients using various androgenic therapies, taking into account the needs of the man, maintaining his reproductive function and risk factors. Particular attention is paid to indications, contraindications and risk factors for androgen therapy in men with diabetes, especially in old age. With this in mind, principles for monitoring the treatment are developed. Based on a large number of studies, favorable effects of androgen replacement therapy in men with hypogonadism and diabetes have been demonstrated. Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

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A study to evaluate the prevalence of hypogonadism in Indian males with Type-2 diabetes mellitus

Cited by 28 publications

References 29 publications

Prevalence of low serum testosterone levels among men with type 2 diabetes mellitus attending two outpatient diabetes clinics in KwaZulu-Natal Province, South Africa

Prevalence of low serum testosterone levels among men with type 2 diabetes mellitus attending two outpatient diabetes clinics in KwaZulu-Natal Province, South Africa

The clinical and epidemiological characteristics of hypogonadism in men with type 2 diabetes mellitus

Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

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