Saad and colleagues evaluated data from 400 men included in a urology registry of patients with hypogonadism (testosterone ≤ 12.1 nmol/L) since 2004; 133 (33.3%) of them had been diagnosed with type 2 diabetes and were treated in a diabetes center. All men received injections of testosterone undecanoate 1,000 mg for 12 weeks for hypogonadism. At least twice a year, anthropometric and metabolic measurements were obtained, and fasting insulin was acquired from the diabetes center to calculate homeostasis model assessment for insulin resistance. Participants were followed for a mean of 6.9 years, with a maximum of 11 years. At baseline, mean age of the participants was 60 years.
The researchers found that at the final measurement, 16 men (12%) were in diabetes remission. They observed a reduction in HbA1c from 8.3% at baseline to 5.7%. Also decreased from baseline to last measurement were fasting glucose (from 7.8 mmol/L to 5.4 mmol/L) and fasting insulin (from 24.7 µU/mL to 7.6 µU/mL). HOMA-IR decreased from 8.7 to 1.8, and triglycerides dropped from 3.2 mmol/L to 2.2 mmol/L.
A decrease in body weight from baseline was observed, from 107 kg to 89 kg, and a reduction in waist circumference from 108 cm to 97 cm. At baseline, all participants had been prescribed oral metformin, and five were on a regimen of insulin at an average dose of 21.6 units per day. Patients were observed for an average of 106.3 months. Discontinuation of diabetes medication occurred at an average of 74.8 months. One patient discontinued testosterone after a diagnosis of low-grade prostate cancer and, subsequently, developed new-onset type 2 diabetes. This patient again experience diabetes remission 48 months after resuming testosterone therapy. Because all injections were given in the urology office, medication adherence was 100%.
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