t is estimated that 285 million people worldwide are affected by diabetes mellitus. By 2030, around 438 million people will be affected by diabetes mellitus. About 66% of this population is in low to middle income countries (1). As compared to western population, Asian population has a much higher tendency to develop diabetes. This occurs at a younger age, at lower degrees of obesity and a much higher rate given for the same amount of weight compared to Western population (2).
Totaltestosterone is largely determined by circulating sex hormone binding globulin. In normal As shown in the table above, the baseline characteristics of all the participants are showed in the
A total of 121 patients were taken in the study who consistently attended the diabetes clinic from May 2017 to May 2018 were taken in the study. 120. For diagnosis of diabetes HbA1c level of ? 6.5 was taken. Serum testosterone levels were measured in all the participants. All calculations were done statistically. P value of <0.05 was considered to be statistically significant. Many studies have reported that there is a high prevalence of low serum testosterone in men with type 2 diabetes mellitus (3, 4, and 5). Some studies have also showed a co-relation between reduced total testosterone and insulin resistance and then subsequent development of diabetes mellitus (6,7). The symptoms of low serum testosterone are loss of libido, erectile dysfunction, reduced muscle mass, low energy, increased adiposity (8,9). 40 ± 6.7. Average height was 168 ±5.3cm in the diabetic patients and 170 ± 4.2cm in the normal population. Average weight was 73 ± 6.5kgs in the diabetic patients and 69 ± 7.4 in the normal population. 66 patients with diabetes never smoked while 72 participants in the normal population were non-smokers. The number of former smokers in the diabetic patients and normal pupation was 12 and 10 respectively. Current smokers are 43/121 in the diabetic patients and 38/120 in the normal population. 39 patients in the diabetic population were hypertensives and 118 were normotensives. 2 patients were hypertensive in the normal population and 92 were normotensive. 17 patients had dyslipidaemia and 104 did not have dyslipidaemia in the diabetic population. 14 participants had dyslipidaemia and 106 participants did not have dyslipidaemia in the normal population. Mean duration of diabetes was 5.6 ± 1.67. Mean HbA1c was 7.8 ± 0.8 in the diabetic population and 4.7 ± 0.3 in the normal population. Serum testosterone level in the diabetic population was 312±14.6 ng/dl. In the normal population, it was 678±17.5ng/dl. After applying student t test, the p value was calculated to be 0.02. This is less than 0.05 which shows that the difference in the two group is significant and not due to chance.
Many studies have shown that about 25% of patients with type 2 diabetes mellitus have low serum testosterone levels. About 4% have subnormal testosterone concentrations with high FSH and H (10). Some studies have also shown that low serum testosterone is associated with diabetes related sexual dysfunction.
A study from Australia showed that 43% of type 2 diabetes patients have total testosterone levels less than 10 (11). A study from United Kingdom showed that 355 men with type 2 diabetes mellitus have total testosterone levels of less than 8 and 25% had symptoms of hypogonadism associated with 8-12 total testosterone (12). 33.2% type 2 diabetes patients had hypogonadism in a study in Egypt (13). A study from Brazil also showed that free testosterone and total testosterone levels were low in type 2 diabetes patients (14). The Endocrine society also recommends measuring the levels of testosterone of patients with type 2 diabetes on a regular basis (15,16). Many cross-sectional and longitudinal studies have showed that with the increase in age the level of total testosterone reduces in men (17,18,19).
Many studies have also showed a co-relation between BMI and low serum testosterone levels in type 2 diabetes mellitus. However, these studies are controversial. Some studies have showed that the association between BMI and serum testosterone is significant (20,21). On the contrary, there is also a study that has showed no co-relation between BMI and low testosterone (22).
There are many limitations of this study. It is a cross-sectional study and so we could not find the trend of the serum testosterone levels in the participants. From our study and conclusion, we can strongly say that an early universal screening program can help in diagnosis of low serum testosterone levels and testosterone supplementation can be started accordingly. We recommend that all patients of type 2 diabetes mellitus undergo screening for serum testosterone. A hormonal baseline can also be established for comparison in future follow-ups.
Type 2 diabetes mellitus is associated with low levels of serum testosterone levels in our study population with a p value significance of 0.02.
| men, 54% testosterone is bound to albumin and other | ||||||
| proteins, 44% is bound to sex hormone binding globulin | ||||||
| and 2% is in unbound state. Some studies believe that low levels of serum testosterone are associated with changes in the levels of FSH and LH. There is an ongoing controversy about whether the low serum levels | Year 2018 | |||||
| of | serum | testosterone | are | associated | with | 21 |
| hypogonadotropic hypogondotrophoism or not. The study by Ali et all showed that in patients with diabetic neuropathy, low serum testosterone levels were associated with low FSH and low LH. In this study, we tried to find a co-relation between levels of serum testosterone and type 2 diabetes mellitus. | Volume XVIII Issue III Version I | |||||
| D D D D ) F | ||||||
| ( | ||||||
| Medical Research | ||||||
| Global Journal of | ||||||
| © 2018 Global Journals | ||||||
| Diabetic | Normal | |
| Patients | Population | |
| Age (yrs) | 42 ±5.7 | 40 ±6.7 |
| Height (cm) | 168 ±5.3 | 170 ±4.2 |
| Weight (kg) | 73 ±6.5 | 69 ±7.4 |
| Smoking : Never | 66 | 72 |
| Smoking : Former | 12 | 10 |
| Smoking: Current | 43 | 38 |
| Hypertension: Yes | 39 | 2 |
| Hypertension: No | 118 | 92 |
| Dyslipidaemia : Yes | 17 | 14 |
| Dyslipidaemia: No | 104 | 106 |
| Duration of Diabetes | 5.6 ±1.67 | |
| Mean HbA1c | 7.8 ±0.8 | 4.7 ±0.3 |
| Type 2 Diabetes | Control | P Value | |
| Serum | |||
| Testosterone | 312±14.6 | 678±17.5 | 0.02 |
| Levels (Ng/Dl) |
Hypogonadotropic hypogonadism in erectile dysfunction associated with type 2 diabetes mellitus: a common defect?. Metab Syndr Relat Disord 2003 Mar: 1. (1) p. .
Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur Surg Res 1998. (1) p. .
Low testosterone levels are common and associated with insulin resistance in men with diabetes. J. Clin Endocrinol Metab 2008 May: 93. (5) p. .
A practical guide to male hypogonadism in the primary care setting. Int J Clin Pract 2010 May: 64. (6) p. .
A practical guide to male hypogonadism in the primary care setting. Int J Clin Pract 2010 May: 64. (6) p. .
Update: Hypogonadotropic hypogonadism in type 2 diabetes and obesity. Clin Endocrinol Metab 2011 Sep: 96. (9) p. .
Hypogonadism, erectile dysfunction, and type 2 diabetes mellitus: what the clinician needs to know. Postgrad Med 2010 Nov: 122. (6) p. .
Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006 Jun. (6) p. .
Serum testosterone levels in diabetic men with and without erectile dysfunction. Andrologia 2012 Dec. (6) p. .
The role of obesity and type 2 diabetes mellitus in the development of male obesity-associated secondary hypogonadism. Clin Endocrinol (Oxf) Saboor Aftab S. A., Kumar S., Barber T. M (ed.) 2013 Mar. 78 (3) p. .