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

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 (R), 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 8.0 nmol/l. For borderline hypogonadism (serum total testosterone 8-11.99 nmol/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 (13.6 nmol/l 95%CI: 13.1-14.2) vs type 1 diabetes (17.9 nmol/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/m(2) 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. (C) 2011 Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe.