madman
Super Moderator
OBJECTIVE Type 2 diabetes (T2D) is a public health threat. Prediabetes represents a window of opportunity for intervention to prevent T2D. Men with T2D and prediabetes often have low testosterone. Since testosterone improves glycemic control in T2D, we investigated whether testosterone therapy (TTh) in men with hypogonadism and prediabetes prevents progression to T2D.
RESEARCH DESIGN AND METHODS Three hundred sixteen men with prediabetes (defined as HbA1c 5.7–6.4%) and total testosterone levels £12.1 nmol/L combined with symptoms of hypogonadism were analyzed. Two hundred twenty-nine men received parenteral testosterone undecanoate (T-group), and 87 men with hypogonadism served as untreated control subjects. Metabolic and anthropometric parameters were measured twice yearly for 8 years.
RESULTS HbA1c decreased by 0.3960.03% (P<0.0001) in the T-group and increased by 0.636 0.1% (P < 0.0001) in the untreated group. In the T-group, 90% achieved normal glucose regulation (HbA1c <5.7%). In the untreated group, 40.2% progressed to T2D (HbA1c >6.5%). TTh was also associated with significant improvements in fasting glucose, triglyceride:HDL ratio, triglyceride-glucose index, lipid accumulation product, total cholesterol, LDL, HDL, non-HDL, triglycerides, and Aging Males’ Symptoms (AMS) scale. Significant deterioration in all these parameters was seen in the untreated group. Mortality was 7.4% in the T-group and 16.1% in the untreated group (P < 0.05). The incidence of nonfatal myocardial infarction was 0.4% in the T-group and 5.7% in the untreated group (P < 0.005).
CONCLUSIONS Long-term TTh completely prevents prediabetes progression to T2D in men with hypogonadism and improves glycemia, lipids, and AMS score. TTh holds tremendous potential for the large and growing population of men with prediabetes and hypogonadism.
CONCLUSIONS
In this observational study of patients treated in real-world clinical venues, we report the effects of long-term TTh for 8 years in men with hypogonadism and prediabetes. Our main finding is that TTh completely prevented the progression of prediabetes to overt T2D as diagnosed on the basis of HbA1c values. Not a single man with hypogonadism and prediabetes who was treated with testosterone progressed to overt T2D. In contrast, 40.2% of untreated men with hypogonadism and with prediabetes developed overt T2D. To our knowledge, this study is the first to show that TTh can completely prevent prediabetes progression to overt T2D. Thus, TTh for hypogonadism fulfills the critical therapeutic goal in patients with prediabetes, which is the prevention of progression to T2D as underscored in the National Diabetes Education Program Guiding Principles for the Care of People With or at Risk for Diabetes.
Testosterone treatment holds tremendous potential for the prevention of diabetes in the rapidly growing population of men with hypogonadism and prediabetes and warrants further investigation in randomized controlled trials as well as replication in additional real-life observational studies conducted in both primary care and specialist practice.
RESEARCH DESIGN AND METHODS Three hundred sixteen men with prediabetes (defined as HbA1c 5.7–6.4%) and total testosterone levels £12.1 nmol/L combined with symptoms of hypogonadism were analyzed. Two hundred twenty-nine men received parenteral testosterone undecanoate (T-group), and 87 men with hypogonadism served as untreated control subjects. Metabolic and anthropometric parameters were measured twice yearly for 8 years.
RESULTS HbA1c decreased by 0.3960.03% (P<0.0001) in the T-group and increased by 0.636 0.1% (P < 0.0001) in the untreated group. In the T-group, 90% achieved normal glucose regulation (HbA1c <5.7%). In the untreated group, 40.2% progressed to T2D (HbA1c >6.5%). TTh was also associated with significant improvements in fasting glucose, triglyceride:HDL ratio, triglyceride-glucose index, lipid accumulation product, total cholesterol, LDL, HDL, non-HDL, triglycerides, and Aging Males’ Symptoms (AMS) scale. Significant deterioration in all these parameters was seen in the untreated group. Mortality was 7.4% in the T-group and 16.1% in the untreated group (P < 0.05). The incidence of nonfatal myocardial infarction was 0.4% in the T-group and 5.7% in the untreated group (P < 0.005).
CONCLUSIONS Long-term TTh completely prevents prediabetes progression to T2D in men with hypogonadism and improves glycemia, lipids, and AMS score. TTh holds tremendous potential for the large and growing population of men with prediabetes and hypogonadism.
CONCLUSIONS
In this observational study of patients treated in real-world clinical venues, we report the effects of long-term TTh for 8 years in men with hypogonadism and prediabetes. Our main finding is that TTh completely prevented the progression of prediabetes to overt T2D as diagnosed on the basis of HbA1c values. Not a single man with hypogonadism and prediabetes who was treated with testosterone progressed to overt T2D. In contrast, 40.2% of untreated men with hypogonadism and with prediabetes developed overt T2D. To our knowledge, this study is the first to show that TTh can completely prevent prediabetes progression to overt T2D. Thus, TTh for hypogonadism fulfills the critical therapeutic goal in patients with prediabetes, which is the prevention of progression to T2D as underscored in the National Diabetes Education Program Guiding Principles for the Care of People With or at Risk for Diabetes.
Testosterone treatment holds tremendous potential for the prevention of diabetes in the rapidly growing population of men with hypogonadism and prediabetes and warrants further investigation in randomized controlled trials as well as replication in additional real-life observational studies conducted in both primary care and specialist practice.
