Screening for hypogonadism in diabetes 2008/9: Results from the Cheshire Primary Care cohort.

Abstract: Aim: There is increasing awareness of hypogonadism in men with type 2 diabetes but limited data from Primary Care. Subjects and methods: The anonymised records of 6457 male patients aged 18–80 years with diabetes were accessed. Within the last 2 years 391 men (6.0% of total) underwent measurement of serum testosterone. Data search was performed through the centralised data facility afforded by EMIS^®, the majority GP systems provider in Cheshire. Results: 4.4% of type 2 diabetes men screened were frankly hypogonadal with a serum total testosterone of less than 8.0nmol/l. For borderline hypogonadism (serum total testosterone 8–11.99nmol/l) the proportion of type 2 diabetes men rose to 32.1%. Age adjusted mean (geometric) testosterone was lower in men with type 2 diabetes (13.6nmol/l 95%CI: 13.1–14.2) vs type 1 diabetes (17.9nmol/l; 95%CI 15.2–21.0), F =10.3; p =0.0014. For those screened age adjusted body mass index (BMI) was greater in type 2 diabetes at 30.7 (30.1–31.3) vs 28.4 (26.1–30.6)kg/m² in type 1 diabetes (F =4.3; p =0.04). Multiple linear regression analysis indicated that there was a statistically significant interaction (P =0.014) between BMI and diabetes type in their relation with log testosterone. For persons with type 1 DM and type 2 DM, testosterone can be expected to decrease by 6% (P =0.002) and by 1% (P =0.002) respectively, for every one unit increment in BMI. Conclusions: There is manifestly a subset of men with diabetes and androgen deficiency who could benefit from testosterone replacement. BMI has an independent influence on androgen status. [Copyright &y& Elsevier]