Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control
Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control
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DOI：
10.1016/j.metabol.2003.12.016
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发表时间：
2004-05-01
影响因子：
9.8
通讯作者：
Miralles, JM
中科院分区：
文献类型：
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作者：
Corrales, JJ;Burgo, RM;Miralles, JM
男性的衰老与2型糖尿病和性腺功能减退的高发病率有关。然而，关于2型糖尿病男性在衰老过程中部分雄激素缺乏（称为男性更年期）的复杂症状和激素变化的信息很少。在这里，我们首次结合临床和激素标准来定义男性更年期，并分析55名2型糖尿病男性（63.6 +/- 7.9岁，平均+/- SD）的雄激素环境与葡萄糖代谢之间的关系。血浆总睾酮（低于或等于53.4 ng/mL）和游离睾酮（低于或等于11 pg/mL）水平低的糖尿病男性分别为20%和54.5%。总睾酮水平低于正常水平的糖尿病男性比例随着年龄的增长而增加：14.2%（50至59岁），17.4%（60至69岁）和36%（60至70岁）。游离睾酮低于正常值的相应数字分别为38%、69.6%和54.5%。在整个2型糖尿病男性组中，总睾酮或游离睾酮与空腹血糖、胰岛素、c肽或果糖胺值之间没有明显的线性相关性。总睾酮与糖化血红蛋白（HbA(1c)）水平呈正相关（r = 0.322, P = 0.01）。虽然老年2型糖尿病伴有男性更年期的患者的空腹血糖略高于无男性更年期的患者（162 +/- 6.9 vs 139 +/- 8.9，平均+/- SEM， P = 0.05），但两个亚组的空腹胰岛素、c肽、果糖胺或HbA（1c）水平没有差异。采用替代疗法（每14天肌肉注射150 mg睾酮酸酯，持续6个月）对10例临床特征为男性更年期与血清睾酮浓度过低相关的2型糖尿病男性患者进行治疗。治疗导致血浆总睾酮（基线：3.9 +/- 0.3；6个月时：7.1 +/- 0.9 ng/mL，平均SEM， P = 0.003）和游离睾酮（基线：9.3 +/- 0.6；6个月时：17.6 +/- 2.4 pg/mL, P = 0.003）显著增加，但对总体血糖控制无明显影响。这些数据表明，在老年2型糖尿病男性中，男性更年期的患病率很高，这表明内源性雄激素环境以及纠正部分雄激素缺乏对血糖控制没有显著影响。(C) 2004爱思唯尔公司版权所有。
Aging in the male is associated with both a higher incidence of type 2 diabetes and hypogonadism. However, little information is available about the complex of symptoms and hormonal changes related to partial androgen deficiency in aging (called andropause) in type 2 diabetic men. Here, for the first time, we used a combination of clinical and hormonal criteria to define andropause and to analyze the relationships between the androgen environment and glucose metabolism in 55 type 2 diabetic men (63.6 +/- 7.9 years, mean +/- SD). Low plasma levels of total testosterone ( less than or equal to 53.4 ng/mL) and free testosterone ( less than or equal to 11 pg/mL) were found in 20% and 54.5%, respectively, of the diabetic men. The fraction of diabetic men with subnormal levels of total testosterone increased with aging: 14.2% (50 to 59 years), 17.4% (60 to 69 years) and 36% ( > 70 years). The corresponding figures for subnormal values of free testosterone were 38%, 69.6%, and 54.5%, respectively. In the whole group of type 2 diabetic men, no significant linear correlations between total or free testosterone with fasting plasma glucose, insulin, C-peptide, or fructosamine values could be established. Total testosterone was positively correlated with glycosylated haemoglobin (HbA(1c)) levels (r = .322, P = .01). Although fasting plasma glucose was marginally higher in aging type 2 diabetic patients with andropause than in those without andropause (162 +/- 6.9 v 139 +/- 8.9, mean +/- SEM, P = .05), there were no differences between both subgroups for plasma fasting insulin, C-peptide, fructosamine, or HbA(1c) levels. Replacement therapy (150 mg intramuscular [IM] of enanthate of testosterone every 14 days for 6 months) was applied in 10 type 2 diabetic men with clinical features of andropause associated with subnormal concentrations of serum testosterone. The treatment induced significant increases in total plasma testosterone (baseline: 3.9 +/- 0.3; at 6 months: 7.1 +/- 0.9 ng/mL, mean SEM, P = .003) and free testosterone (baseline: 9.3 +/- 0.6; at 6 months 17.6 +/- 2.4 pg/mL, P = .003), but had a neutral effect on overall glycemic control. These data show a high prevalence of andropause in aging type 2 diabetic men and suggest that the endogenous androgen environment, as well as correction of the partial androgen deficiency, do not have a meaningful effect on glycemic control. (C) 2004 Elsevier Inc. All rights reserved.