Background: To date, it has been established that appointment of testosterone replacement therapy (TRT) in men with type 2 diabetes mellitus (T2DM) and testosterone (T) deficiency improves control of carbohydrate metabolism. Although, studies of effectiveness of different hypoglycemic drugs in men with T2DM and T deficiency have not been conducted. The aim of this study was to compare the efficacy of various types of hypoglycemic therapy in patients with T2DM and late onset hypogonadism, as well as an assessment of its combination with TRT.
Materials and methods: We examined 90 men with T2DM and late onset hypogonadism, diagnosed by European Association of Urology criteria (2016). 40 patients, receiving TRT (Androgel 50 mg/day) for 9 months, were divided into 2 groups: 1 20 men, receiving sulfonylureas therapy and metformin, 2 20 patients treated with dipeptidyl peptidase type 4 (DPP-4) inhibitors and metformin. The control groups (patients with T deficiency without TRT) included 50 men: group 3 25 patients using sulfonylureas and metformin therapy, group 4 25 patients treated with DPP-4 inhibitors and metformin. All patients underwent clinical examination and assessment of carbohydrate metabolism. Statistical processing of data was carried out using Wilcoxon test (Statistics 11.0).
Results: The greatest dynamic of weight loss was found in group 2 BMI reduced from 34.7 (30.6; 39.1) to 32.6 (29.6; 34.7) kg/m2 (P=0.008), waist circumference (WC) by 8.7±0.3 cm (P=0.01), hip circumference (HC) by 5.1±0.4 cm (P=0.03). The assessment of anthropometric indices showed a decrease in body weight by 0.5±0.2 kg and BMI by 0.1±0.05 kg/m2 in group 1, which werent significant, while in the 3rd group there was a weight gain by 3.1±0.3 kg (P=0.04). In group 4 significant changes did not occurred. The study of carbohydrate metabolism revealed a decrease in HbA1c by 0.3±0.1%, fasting glucose by 0.6±0.2 mM/l (P=0.08) in the 1st group, but no significant changes in the 2nd and 4th groups, whereas there was a slight deterioration in the parameters of carbohydrate metabolism in group 3. The frequency of hypoglycemic events was higher in patients receiving sulfonylureas (groups 1 and 3), which reflects an increase in cardiovascular risks in these patients.
Conclusion: The administration of TRT in men with T2DM and late onset hypogonadism, improves metabolic control. The optimal treatment tactic for these patients is the DPP-4 inhibitors and metformin in combination with TRT.
18 - 21 May 2019
European Society of Endocrinology