Clinical and metabolic peculiarities in male patients with type 2 diabetes mellitus and hypogonadism

It is now well known that hypogonadism is detected in at least every third male patient with type 2 diabetes mellitus (T2 DM). According to recent data, the prevalence of hypogonadism in T2 DM may exceed 50%. At the same time, androgen deficiency is considered today as an independent risk factor for mortality. Therefore, studying the characteristics of the course of T2 DM in male patients with androgen deficiency is of particular interest.

The aim: to study the clinical and metabolic peculiarities of type 2 diabetes in male patients with testosterone deficiency. Target functions: to identify the prevalence of testosterone deficiency in different age groups in male patients with T2 DM; to estimate the incidence of hypogonadism, including also among men having diabetes mellitus for about ≤1 year; to compare anthropometric characteristics of male patients with T2 DM and hypogonadism and without it; to compare carbohydrate metabolism rates in both groups; to estimate cardiovascular risk (CVR) factors – the frequency of arterial hypertension (AH) and lipid profile indexes.

Material and methods. The first stage included laboratory diagnosis of hypogonadism in the general population of male patients with T2 DM (n=287). The second stage of the study included only patients with less than 1 year of diabetes mellitus 2, subject to compensation of carbohydrate metabolism – a totally 36 persons (19 with diagnosed hypogonadism and 17 without hypogonadism). Serum analysis for total testosterone was performed from 07.00 to 11.00 am. At all stages of the study, BMI, waist circumference (WC), hip circumference (HC), WC/HR were estimated, bioimpedance analysis of body composition and blood pressure measurements were also performed. Laboratory parameters included HbA1c, fasting plasma glucose, and lipid profile.

Results. The incidence of hypogonadism was 46,8% in the general sample of patients (42,8% among men <55 years old and 51,1% among men ≥55 years old) and 52,8% in the second stage of the study among men with ≤1 year of DM duration. Patients with hypogonadism had a higher % of fat mass and a tendency to higher Waist/Hips measurement index. AH in male patients with hypogonadism took place more common, and the lipid profile had more atherogenic characteristics.

Conclusion. Among male patients with T2 DM, even with compensation of carbohydrate metabolism, hypogonadism occurs in almost every second case, regardless of age. Male patients with T2 DM and androgen deficiency have potentially higher CVR due to severe atherogenic dyslipidemia and more often developing AH. Moreover, male patients with androgen deficiency and T2 DM lasting ≤1 year, even with carbohydrate metabolism compensation, also have a higher % of fat mass and CVR, which dictates the need for an independent assessment of testosterone levels in newly diagnosed T2 DM, especially in patients with visceral obesity.