Primary and Secondary Hypogonadism in Male Persons with Diabetes Mellitus.

João Martin Martins,Dinis Reis,Carlos Lemos,Catarina Martins Maia,Catarina Mota,João Roque,Mafalda De Pina Jorge,Daniel Nunes,Vito Angelo Giagulli

doi:10.1155/2021/8799537

Abstract

Aims To characterize hypogonadism in male persons with diabetes mellitus. Patients and Methods. 184 consecutive male persons with diabetes were studied. Besides the usual care, total testosterone (TT), estradiol (E2), FSH, and LH were measured in the last appointment and in 40 patients, also in the next two appointments. Statistical analysis compared groups and explored factors for TT and LH levels. Results TT levels were stable and highly correlated (r > 0.750, p < 0.001) over a 6–12-month period. 20% of the patients presented secondary hypogonadism (SH) and 18% presented primary hypogonadism (PH). SH was inversely related to HbA1 (partial r (rp) = 0.229, p < 0.005), while PH was directly related to age (r = 0.356, p < 0.001). TT levels were reduced independently by metformin (364 ± 160 vs. 431 ± 242 ng/dL, t = 2.241, p < 0.05) and statins (359 ± 156 vs. 424 ± 230 ng/dl, t = 2.224, p < 0.05). TT levels were inversely related to microvascular disease (rp = −0.169, p < 0.05). Discussion. TT levels were stable over time and hypogonadism was common. SH, generally clinically, is related to the diabetic state, while PH, generally subclinically, is an age-dependent process unrelated to diabetes. Low TT levels were related to older age, poor metabolic control, metformin and statins use, and microvascular disease.

Highlights

IntroductionDiabetes mellitus is a common chronic condition, with a complex and less than optimal treatment, persistent metabolic dysregulation, widespread micro- and macrovascular complications, increased infection susceptibility, bone fractures risk, depressive symptoms, and sleep disturbances, which imposes a significant burden on the patient, family, health services, and society [1,2,3,4].Despite clinical practice recommendations and the chronic care model that empowers patient active self-management in a patient-centered care paradigm, composite targets in multifactorial care are attained in less than 50% of the patients [5].Multiple targets in a multifactorial disease suggest the importance of exploring general factors of the diabetic state.Hypogonadism may occur independently of diabetes mellitus [6, 7]
We systematically explored baseline gonadic function in male persons with diabetes assisted at the outpatient endocrine department of a public central hospital to estimate the frequency of hypogonadism, characterize it, and explore possible relations to diabetic characteristics, pharmacologic drug use, and vascular complications
Insulin resistance has been proposed as yet another mechanism for the association of type 2 diabetes and secondary hypogonadism (SH), we found that metformin that corrects insulin resistance is associated with decreased testosterone levels [33,34,35,36]

Summary

Introduction

Diabetes mellitus is a common chronic condition, with a complex and less than optimal treatment, persistent metabolic dysregulation, widespread micro- and macrovascular complications, increased infection susceptibility, bone fractures risk, depressive symptoms, and sleep disturbances, which imposes a significant burden on the patient, family, health services, and society [1,2,3,4].Despite clinical practice recommendations and the chronic care model that empowers patient active self-management in a patient-centered care paradigm, composite targets in multifactorial care are attained in less than 50% of the patients [5].Multiple targets in a multifactorial disease suggest the importance of exploring general factors of the diabetic state.Hypogonadism may occur independently of diabetes mellitus [6, 7]. Diabetes mellitus is a common chronic condition, with a complex and less than optimal treatment, persistent metabolic dysregulation, widespread micro- and macrovascular complications, increased infection susceptibility, bone fractures risk, depressive symptoms, and sleep disturbances, which imposes a significant burden on the patient, family, health services, and society [1,2,3,4]. Multiple targets in a multifactorial disease suggest the importance of exploring general factors of the diabetic state. Hypogonadism may complicate diabetes mellitus at the very least because of either age or the neuroendocrine adaptation to a chronic condition, but eventually because of the chronic metabolic derangement, micro- and macrovascular disease, and multiple drug use [8,9,10,11]. Hypogonadism further deteriorates metabolic control, cardiovascular risk, and bone and mental health [12,13,14,15]

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Conclusion