Screening for hypogonadism in diabetes 2008/9: results from the Cheshire Primary Care cohort

Prim Care Diabetes. 2012 Jul;6(2):143-8. doi: 10.1016/j.pcd.2011.07.006. Epub 2011 Oct 5.

Abstract

Aim: There is increasing awareness of hypogonadism in men with type 2 diabetes but limited data from Primary Care.

Subjects and methods: The anonymised records of 6457 male patients aged 18-80 years with diabetes were accessed. Within the last 2 years 391 men (6.0% of total) underwent measurement of serum testosterone. Data search was performed through the centralised data facility afforded by EMIS®, the majority GP systems provider in Cheshire.

Results: 4.4% of type 2 diabetes men screened were frankly hypogonadal with a serum total testosterone of less than 8.0 nmol/l. For borderline hypogonadism (serum total testosterone 8-11.99 nmol/l) the proportion of type 2 diabetes men rose to 32.1%. Age adjusted mean (geometric) testosterone was lower in men with type 2 diabetes (13.6 nmol/l 95%CI: 13.1-14.2) vs type 1 diabetes (17.9 nmol/l; 95%CI 15.2-21.0), F=10.3; p=0.0014. For those screened age adjusted body mass index (BMI) was greater in type 2 diabetes at 30.7 (30.1-31.3) vs 28.4 (26.1-30.6)kg/m(2) in type 1 diabetes (F=4.3; p=0.04). Multiple linear regression analysis indicated that there was a statistically significant interaction (P=0.014) between BMI and diabetes type in their relation with log testosterone. For persons with type 1 DM and type 2 DM, testosterone can be expected to decrease by 6% (P=0.002) and by 1% (P=0.002) respectively, for every one unit increment in BMI.

Conclusions: There is manifestly a subset of men with diabetes and androgen deficiency who could benefit from testosterone replacement. BMI has an independent influence on androgen status.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Biomarkers / blood
  • Blood Pressure
  • Body Mass Index
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Chi-Square Distribution
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / physiopathology
  • England / epidemiology
  • Glomerular Filtration Rate
  • Glycated Hemoglobin A / metabolism
  • Hormone Replacement Therapy
  • Humans
  • Hypogonadism / blood
  • Hypogonadism / diagnosis
  • Hypogonadism / drug therapy
  • Hypogonadism / epidemiology*
  • Least-Squares Analysis
  • Linear Models
  • Lipids / blood
  • Male
  • Mass Screening*
  • Middle Aged
  • Primary Health Care
  • Risk Assessment
  • Risk Factors
  • Testosterone / blood
  • Testosterone / deficiency*
  • Testosterone / therapeutic use
  • Time Factors
  • Young Adult

Substances

  • Biomarkers
  • Glycated Hemoglobin A
  • Lipids
  • hemoglobin A1c protein, human
  • Testosterone