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Table of Content - Volume 20 Issue 3 - December 2021


 

Study of testosterone levels in type II diabetes mellitus patients in Telangana population

 

Raj Houns Veershattappa

 

Associate Professor, Department of General Medicine, Mamata Medical College Khammam – 507002, Telangana, INDIA.

Email: rajhansdoctor@gmail.com

 

Abstract              Background: A relationship between testosterone and type-II DM in men is an important issue because one out of five is suffering with type-II DM globally with similar percentage of low testosterone level too. Method: 500 type-II DM patients at different age groups were studied and compared with 250 controlled groups. The clinical investigation included. FBS PP Blood urea S. creatiinine, HBA1C, lipid profile, Urine for albumin creatinine ratio, S. testosterone was estimated by using chemiluminescience immune assay and HbA1c by HPLC. Results: BMI in type-II was 25.83 (±2.33) and controlled was 24.8 (±3.22). Mean HBA1C in type-II DM was 8.81 (±1.93) and 4.80 (±0.402) in controlled group. S. testosterone level was 119.11 (±86.45) in type-II DM and 402 (± 171.52) in controlled groups. Conclusion: This pragmatic study revealed that higher sugar level is inversely proportion to lower testosterone. It will be guide to physician, endocrinologist to treat such patients efficiently to elevate the testosterone levels.

Keywords: Chemilumiescene immune assay, HPLC, HbA1C, Metabolic syndrome, Telangana

 

INTRODUCTION

Low serum testosterone level has been reported in mean with type-2 diabetes mellitus.1 Inverse relationship between the serum testosterone level and cardiovascular risk factors such as obesity, Hypertension, dyslipidemia and insulin resistance have been shown.2 Recent studies have shown that, lows testosterone level is strongly associated with metabolic syndrome (MES) in men belong to different ethnic groups. Low S. testosterone also related to adverse clinical outcomes including cardio-vascular diseases (CVD) and premature mortality.3 The patients with type-II DM have sexual dysfunction, unexplained weight loss, weakness or mobility limitation. Hence interventional trials examining the effects of testosterone replacement on clinical outcomes have been carried out in men with symptomatic androgen deficiently.4 The cause of decreased S. testosterone level in patients with type-II DM is not clear. Hence attempt was made to evaluate the various aetiologies related to low S. testosterone in type-II DM patients with different age groups.

 

MATERIAL AND METHOD

500 adult males and between 30-50 years known diabetes Mellitus regularly visiting to medicine department of Mamata Medical College Hospital Khammum-507002 Telangnana were studied.

Inclusive Criteria: Type-II DM patients irrespective of duration of diabetes currently on oral hypoglycaemic drugs or insulin.

Exclusion Criteria: Patients with age less than 30 years with type-II DM and patients on medications of corticosteroids, testosterone, thyroid supplements, and chronic renal disease, cirrhosis of liver and immune-compromised patients were excluded, from the study.

Method: Detailed history, occupation, clinical examination and investigation included CBC, Fasting and post-parandial blood sugar. Blood urea, serum creatinine HBA1C, lipid profile, Urine for albumin creatinine ratio, Diabetes mellitus was defined by ADA guide lines.5 Serum testosterone levels (Morning sample were estimated using chemiluminescence immunoassay. Low testosterone was defined as serum testosterone level < 241 mg/dl and the prevalence of its deficiencies was calculated. Estimation of HbA1C (4.2-6.2%) performed by High performance liquid chromatography (HPLC). The duration of study was from May-2020 to June-2021

Statistical analysis: Various parameters in type-II DM patients were studied and compared with controlled group. The statistical analysis was carried out in SPSS software.

This research paper was approved by Ethical committee of Mamata Medical College Khammam – 507002, Telangana.

 

OBSERVATION AND RESULTS

Table 1: Clinical manifestation in type-II DM patients. The mean value of age was 55.26 (±11.16), BMI was 25.83 (± 2.33), P-Y was 8.92 (± 13.76), Mean HBA1C was 8.81 (± 1.93), Mean Cholestrol 186.02 (± 72.30), Mean HDL 51.38 (± 11.25). Mean LDL 112.25 (± 49.02). Mean serum creatinine 2.4 (± 2.42), Mean Albumin creatinine ratio -2082 (± 4590), Mean serum testosterone 119.11 (± 86.45)

Table 2: Comparison clinical manifestation type-II DM patients with controlled group.

Mean value Age of DM was 55.26 (± 11.1) and 38.78 (± 7.82) in controlled group. Type-II mean value of MI 25.83 (± 2.33) in type-II DM, 24.89 (± 3.22) in controlled group, Mean HBA1C 8.81 (± 1.93) in DM and 4.80 (± 0.402) in controlled group, serum testosterone 119.11 (± 86.45) in DM group, 402 (± 171.52) in controlled group

Table 3: Distribution of type-II DM patients accounting to duration 120 (± 24%) were > 64 years, 179 (± 35.8%) between 11.15, 64 (± 12.8%) were > 106 years.

 

Table 1: Clinical Manifestations in diabetic patients

(Total No. of patients: 500)

Manifestations

Mean ±SD

Age

55.26 (± 11.16)

RMI

25.83 (± 2.33)

P-Y

8.92 (± 13.76)

Mean HBA1C

8.81 (± 1.93)

Mean cholesterol

186.02 (± 72.30)

Mean HDL

51.38 (± 11.25)

Mean LDL

112.25 (± 49.02)

Mean serum creatinine

2.4 (± 2.42)

Mean Albumin creatinine Ratio

2082 (± 4590)

Mean serum testosterone

119.11 (± 86.45)

High Mean HBA1C and least level of serum testosterone was observed P-Y pack year (year of smoking multiplied by average number of packs or fractions)

 

Table 1: Clinical Manifestations in diabetic patients

 

Table 2: Comparison of clinical Manifestations in type-II DM patients with controlled group

Parameters

II DM patients (500)

Controlled group (250)

Age

55.20 (± 11.16)

38.78 (± 7.82)

BMI

25.83 (± 2.33)

24.89 (± 3.22)

Mean HBA1C

8.81 (± 1.93)

4.80 (± 0.402)

Serum testosterone

119.11 (± 86.45)

402 (± 171.52)

Lowest serum testosterone observed in type-II DM patients

 

Table 2: Comparison of clinical Manifestations in type-II DM patients with controlled group

 

Table 3: Distribution of type-II DM patients according to duration of disease

Duration of years

No of patients (500)

Percentage

> 6 years

120

24

6-10 years

179

35.8

11-15 years

137

27.4

> 16 years

64

12.8

Highest duration of DM patients were observed between 6-10 years and least duration were > 16 years

 

Table 3: Distribution of type-II DM patients according to duration of disease

 

DISCUSSION

The present study of testosterone levels in type-II DM patients in Telangana population. The mean value of age 55.26 (± 11.1%) in type-II DM group, 38.78 (± 7.8%) in controlled group, BMI 25.8 (± 2.3%) in type-II DM, 24.89 (± 3.2%) in controlled group, Mean HBA1C 8.84 (± 1.93) in type-II DM, 4.80 (± 0.40%) in controlled. Serum testosterone 119.1 (± 86.4%) in type-II DM and 402 (± 171.5%) in controlled group (Table-2) Moreover elevated mean cholesterol 186.02 (± 72.3), Mean LDL 51.38 (± 11.2), Mean S. creatinine 2.4 (± 2.47%), Mean Albumin creatinine ratio 2082 (± 4590) was observed in type-II DM patients (Table-1). The highest duration 179 (± 35.8%) were more than +6 years and least were 64 (± 12.88%) was > 16 years (Table-3). These findings are more or less in agreement with previous studies.6,7,8 Defining the lower limit of normal for S. testosterone level poses a challenge for physicians. The adverse clinical outcomes occur in type-II DM is not known.9 Testosterone in men is synthesized and secreted into circulation almost exclusively by cells of leydig of the testes. It is mostly bound to plasma proteins. S. testosterone composed of 0.5 to 3% of free testosterone unbound to plasma proteins, 30-44% sex hormone binding globulin (SHBG) – bound testosterone and 54-60% albumin bound testosterone.10 Moreover variations in S. testosterone metabolism associated with environmental and / or genetic factors.11 It is experimented in lower animals (mouse) that, testosterone therapy in increase, the muscle mass and reduce the fat mass both of which were expected to decrease insulin resistance. It is also observed in mile that, testosterone regulated skeletal muscle genes involved in glucose metabolism that led to decreased systemic insulin resistance.12 It can be hypothesized that, low S. testosterone level could contribute to development of obesity and type-II DM through changes in body composition. In obese men, the peripheral conversion from testosterone to oestrogen could attenuate the amplitude of luteinizing hormone pulses and centrally inhibit testosterone production. Moreover leptin and adipokine has shown to be inversely correlated with serum testosterone level in men. Low testosterone level can be perpetuated through defects in the (HPG) axis. Hence type-II DM patients had hypogonatropic hypo-gonadism. Aging is also well known to result in a decline of sex hormone level and is likely a combination of testosterone and pituitary hypothalamic defects. In elderly men, there is reduced testicular response to gonado-trophins with suppressed and altered pulsality of the hypothalamic pulse generation. Low testosterone is commonly associated with high prevalence of metabolic risk factors including insulin resistance, hypertension, dyslipidemia and obesity (particularly central adiposity), CVD and type-II DM, because testosterone has been shown to dilate coronary vessels in animals and men, suggesting that it might be an important regulator of vasculature compliance and modifier of blood pressure.

 

SUMMARY AND CONCLUSION

Present study of serum testosterone level in type-II DM patients causes insulin resistance, Obesity and vascular dysfunction and inflammation. As there is high prevalence of type-II DM across the world further study of genetic, hormonal, nutritional, pharmacological is required to clarify whether low testosterone is merely a reflection of poor cardio-vascular risk factors control or is really causing adverse clinical outcomes.

 

Limitation of study:

Owing to non-availability of latest techniques and remote location of our medical institution we have limited findings.

 

REFERENCES

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