Diabetes mellitus type 2 (DM-2) occurs when pancreas fails to produce enough insulin or when the body cannot effectively make use of the insulin produced by the pancreas. Among other factors causing DM-2, stress is increasingly regarded as one of the causative agents that make the blood glucose levels rise, and cause DM-2. It has also been reported that DM-2 may be one of the commonest cause of hypogonadism, a lack of function in the testes, which adversely affects testosterone (T) production. Emerging evidence links insulin resistance, a key feature in DM-2 with decreased Leydig cells secretion of T. Low gonadal steroids have been associated with metabolic abnormalities such as hyperglycemia, hypertension and subsequent development of cardiovascular diseases (CVDs). In contrast, low dose T replacement therapy is associated with improvement of these conditions. In view of the foregoing observations, the present study was designed to determine the effect of stress in terms of release of cortisol on the development of diabetes, the interrelationship between diabetes and reproductive function in terms of release of T and their effect on the development of hypertension and related CVDs. Hundred male diabetic hypertensive cardiovascular patients and hundred age matched controls were selected from different hospitals of Dera Ismail Khan Division, KPK, Pakistan. Plasma concentrations of cortisol and T were analyzed using specific RIA kits. The Students t-test, ANOVA and Pearson Correlation r were applied for the interpretation of results. Our results revealed that 68 percent diabetic hypertensive CVD patients had normal cortisol levels, whereas 29 percent had high cortisol concentrations. In addition, 76 percent patients had low T concentrations indicating reproductive dysfunction in these patients. Furthermore, we observed a negative correlation between cortisol and T concentrations in all groups. A positive correlation was observed between cortisol and BP and blood glucose levels. On the other hand, there was a negative correlation between plasma T levels and BP and blood glucose levels in all groups. The majority of diabetic hypertensive cardiovascular male patients belonged to age group of 5160 years. They were illiterate, married, smokers, belonged to the lower middle income socio-economic status, overweight despite performing exercise regularly, had disease duration of 15 years, had no family history of hypertension and were treated with combination of RAASi and non-RAASi. In conclusion, our results indicated that most of diabetic hypertensive cardiovascular patients had low T concentrations no matter whether they had normal or high cortisol concentrations.
18 - 21 May 2019
European Society of Endocrinology