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Background

The Prevalence of Male Hypotestosteronism in Type 2 Diabetics in a Southwest Virginia Population Dr. Eric Hofmeister Dr. Christopher Bishop. Background. Several studies have demonstrated a high prevalence of hypotestosteronism in males with T2DM.

cadman-hodges
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Background

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  1. The Prevalence of Male Hypotestosteronism in Type 2 Diabetics in a Southwest Virginia PopulationDr. Eric HofmeisterDr. Christopher Bishop

  2. Background • Several studies have demonstrated a high prevalence of hypotestosteronism in males with T2DM. • The Hypotestosteronism in Males (HIM) study reported the prevalence of hypogonadism in males with T2DM to be 50%

  3. The HIM Study • 2162 eligible men > 45 years visiting primary care practices in the United States • Serum testosterone assessment by a single morning blood draw • Hypogonadism defined as total testosterone level < 300 ng/dL with one or more symptoms • Prevalence of hypogonadism in males with T2DM was 50%

  4. Hypothesis • The prevalence of male hypotestosteronism within our local Southwest Virginia population is greater than 50%

  5. Objective • Determine the Prevalence of hypotestosteronism in males with type II diabetes mellitus (T2DM) within a local population in Southwest Virginia.

  6. Design • Non-randomized retrospective analysis • 13 months • Data Analysis of all type 2 diabetic males that had received a total testosterone assessment

  7. Methods • Solstas Lab Database • All patients that had received a total testosterone level assessment over a 13 month period • Utilized a T2DM inclusion / exclusion criteria to determine sample population

  8. Methods • T2DM males assessed for the presence of hypotestosteronism by chart review (Allscripts Database) of a documented total serum testosterone level of less than 300 ng/dL • Excluded if no documentation of prior serum total testosteronism < 300 ng/dL • Determined percentage of T2DM males with a total testosterone level < 300 ng/dL

  9. Inclusion / Exclusion Criteria • Male of any age • Type II Diabetes  A1C > 6.5 or fasting blood glucose > 126 mg/dL • Exclude  No documented A1C or fasting blood glucose level documentation, Hx of Type I Diabetes, chronic steroid use, or Hx of hypopituitarism

  10. Sample Analysis 127 excluded (no gluc/A1c) 38 excluded (DM1, steroids..)

  11. Results • 41/59 (69.5%) have low T with T2DM • 18/59 (31.5%) have normal T with T2DM 4

  12. Demographics Mean patient age 54.5 Mean BMI 33.6 Mean testosterone 207 Mean A1c 7.9 Mean serum glucose 144

  13. Concomitant Conditions Opioid use 39 % (16/41) Hypothyroidism 32 % (13/41) Oral hypoglycemics 73 % (30/41) Insulin therapy 41 % (17/41) CVD/CAD/MI 37 % (15/41) Tobacco smoking 37 % (15/41)

  14. Discussion • Prevalence of T2DM in US high (26 million) and increasing • Increasing incidence of hypotestosteronism ? • No current recommendations regarding screening for low testosterone in males • Low testosterone associated with insulin resistance and T2DM independent of age, race, BMI 4

  15. Discussion • Testosterone supplementation therapy shown in multiple studies to improve: • insulin resistance/utilization • Hemoglobin A1c • serum glucose • DBP • Total, HDL, & LDL cholesterol • increase lean body mass, decrease fat mass, waist circumference 4

  16. Low Testosterone & Cardiovascular Disease • Multiple, conflicting studies… the good: • Several studies show an inverse relationship between cardiovascular disease and testosterone level • T2DM patients with high-normal testosterone have lower risk (25%) of acute MI vs lowest 25% 4

  17. Low Testosterone & Cardiovascular Disease • Multiple, conflicting studies… the bad: • Some studies report an increased risk of non-fatal MI in middle-age and elderly patients with pre-existing heart disease given testosterone replacement • National Institute for Aging study • Veterans’ studies (JAMA, NEJM): 26% vs 20% risk of veterans for MI, stroke, and/or death 4

  18. Testosterone Therapy Risks • Increased PSA.. worsening BPH • Hematopoiesis  hyperviscocity • Gynecomastia • Worsening male breast CA ? • OSA/insomnia • Decreased spermatogenesis • Increased or decreased heart disease? 4

  19. Testosterone Therapy and Prostate Cancer • No evidence between exogenous testosterone and increase incidence or progression of prostate CA • Current evidence based largely on Huggins & Hodges study (1941). Several studies since 1941 have refuted that evidence… however ??? 4

  20. Final Discussion • Higher prevalence of hypotestosteronism in SWVA T2DM patients vs. nationally? • Should we screen? • Should we recommend therapy? 4

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