Testosterone Level And Its Influencing Factors In Male Type 2 Diabetes Mellitus

Objective: The aim of this study was to investigate the serum total testosterone（TT）level in male patients with type 2 diabetes mellitus（T2DM）,and to explore the effects of body mass index（BMI）,blood glucose,blood lipid levels,diabetes complications and comorbidities on the level of testosterone.Methods: A total of 554 male T2 DM patients hospitalized in the Department of Endocrinology,Affiliated Hospital of Jining Medical College from November 2019 to April 2021 were enrolled in this study.General information such as age,medical history,smoking history,drinking history,etc.,and anthropometric indicators such as waist circumference,hip circumference,height,weight and blood pressure were measured.Body mass index（BMI）and waist-to-hip ratio（WHT）were calculated,and laboratory indicators including blood glucose,blood lipids,liver and kidney function,and sex hormones were measured.The study population was divided into low testosterone group（TT<3.5ng/ m L）and normal testosterone group（TT≥3.5ng/ml）according to the tangent point of testosterone value 3.5 ng/ml.The independent sample T test and Mann-Whitney U test in SPSS software were used to compare the continuous variables of normal and skewness distribution between the two groups,respectively.Spearman correlation analysis and Logistic regression analysis were used to analyze the independent correlation factors of low TT.Results :（1）A total of 554 male T2 DM patients were enrolled,with an average age of（52.71±12.6）years and an average testosterone level of（3.93±1.48）ng/ m L.There were 232 male T2 DM patients in the low testosterone group,accounting for 41.9% of all male T2 DM patients.Compared with the normal testosterone group,BMI,waist circumference,WHT,TG,HOMA-IR,alanine aminotransferase（ALT）levels were higher in the low testosterone group,the duration of diabetes was shorter,and HDL-C levels were lower.There were no significant differences in age,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,TC,FBG,Hb A1 c,aspartate aminotransferase（AST）,creatinine（Cr）and uric acid（UA）between the two groups.In terms of sex hormones,estradiol（E2）and luteinizing hormone（LH）levels were lower in the low-testosterone group than in the normal testosterone group,and there was no statistically significant difference in follicle stimulating hormone（FSH）levels between the two groups.In terms of diabetes complications and comorbidities,the prevalence of diabetic retinopathy and diabetic peripheral vascular disease was lower in the low testosterone group,and the prevalence of hypertension was higher.（2）Single factor analysis of TT and BMI,Hb A1 c,FCP and lipid profile: TT was negatively correlated with BMI,WHR,TG,FCP,Hb A1 c and AST（P < 0.05）,while TT was positively correlated with HDL-C（P < 0.05）.There was no significant correlation between TT and SBP,DBP,TC,LDL-C,FBG,HOMA-IR,ALT,TBIL,DBIL,IBIL,Cr and UA（P > 0.05）.（2）Spearman correlation was used to analyze the relationship between low TT and variables in male T2 DM patients.The results showed that the occurrence of low TT was positively correlated with BMI,WHT,waist circumference,TG,HOMA-IR,ALT,fatty liver and hypertension（P < 0.05）.It was negatively correlated with the course of diabetes,HDL,E2,LH,diabetic retinopathy and diabetic peripheral vascular disease（P < 0.05）.There was no significant correlation with age,smoking and drinking history,SBP,DBP,Hb,TC,LDL-C,FBG,Hb A1 c,AST,Cr,UA,FSH,diabetic nephropathy,diabetic peripheral neuropathy and coronary heart disease（P > 0.05）.（3）According to the results of Spearman correlation analysis,low TT was taken as the dependent variable,BMI,WHT,waist circumference,TG,HOMA-IR,ALT,fatty liver,hypertension,diabetes course,HDL,E2,LH,diabetic retinopathy and diabetic peripheral vascular disease were not independent variables,Logistic regression was used to analyze the independent correlation factors of low TT.Waist circumference（OR=1.05,95%CI: 1.02,1.08,P<0.010）,HDL-C（OR=0.30,95%CI: 0.12,0.74,P=0.009）,E2（OR=0.97,95%CI: 0.95,0.98,P<0.010）,fatty liver（OR=2.12,95%CI: 1.38,3.25,P=0.001）,diabetic retinopathy（OR=0.54,95%CI: 0.33,0.89,P=0.015）,diabetic peripheral vascular disease（OR=0.53,95%CI: 0.34,0.83,P=0.005）,hypertension（OR=1.60,95%CI:1.02,2.50,P=0.039）entered the regression model and were significantly independently correlated with low TT（all P<0.05）.Conclusions: In this study,the prevalence of low testosterone in male T2 DM patients was 41.9%.Waist circumference,fatty liver and hypertension were positively correlated with low TT.HDL-C,E2,diabetic retinopathy and diabetic peripheral angiopathy were negatively correlated with low TT,so it is necessary to pay attention to the testosterone level of the previous T2 DM patient.Combined with the patient’s history and clinical indicators,the testosterone level of the patient can be roughly evaluated.