This study explores the links between testosterone deficiency and Quality Outcomes Framework (QOF) parameters in three south Staffordshire practices prior to a major double-blind placebo-controlled intervention study. Research design and methods:
Four hundred and eighty-eight consecutive type 2 diabetic patients, aged over 18, attending their general practitioner for routine diabetes visits were assessed for sex hormone binding globulin, total testosterone (TT), calculated free testosterone (FT) and bioavailable testosterone, glycated haemoglobin A1c (HbA1c), body mass index, waist circumference, blood pressure, lipid profile, Sexual Health Inventory for Men, and current and past prescriptions for erectile dysfunction (ED).
Results:
TT and FT were significantly inversely associated with raised body mass index, waist circumference and HbA1C. The prevalence of ED was 77%, which was associated with low levels of TT, FT and raised HbA1C. Only 10% were receiving treatment for ED.
Conclusions:
Patients with low testosterone were more likely to fall outside the QOF targets and new markers might be difficult to achieve unless low testosterone is addressed. There is a strong case for the inclusion of TT and FT estimation in routine diabetic care.
Kapoor D., Aldred H., Clark S. et al. Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: Correlations with bioavailable testosterone and visceral adiposity, Diabetes Care2007;30:911-17.
2.
Dhindsa S., Prabhakar S., Sethi M. et al. Frequent occurrence of hypogonadotrophic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab2004;89:5462-8.
3.
Laaksonen DE , Niskanen L., Punnonen K. et al. Sex hormones, inflammation and the metabolic syndrome: a population based study. Eur J Endocrinol2003;149:601-8.
4.
Kupelian V., Page ST, Araujo AB et al. Low sex hormone binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab2006 ;91:843-50.
5.
Connecting for Health: the 2004 GP contract. www.connectingforhealth.nhs.uk/systemsandservices/ssd/downloads/newgpcontractpay/ngmscontents . Last accessed September 2009.
6.
Simon D., Charles MA, Nahoul K. et al. Association between plasma total testosterone and cardiovascular risk factors in healthy adult men: The Telecom Study. J Clin Endocrinol Metab1997;82:682-5.
7.
Hak AE, Witteman JCM, De Jong FH et al. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam Study. J Clin Endocrinol Metab2002;87:3632-9.
8.
Laughlin GA, Barrett-Connor E., Bergstrom J.Low serum testosterone and mortality in older men. J Clin Endocrinol Metab2008;93:68-75.
9.
Hackett G., Kell P., Ralph D. et al. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction. J Sex Med2008;5:1841-6.
10.
Wespes E., Amar E., Hatzichristou DG et al. EAU guidelines on erectile. dysfunction. Eur Urol2002;41:1-5.
11.
National Institute for Health and Clinical Excellence NICE guidance on Type 2 Diabetes (66). London: NICE, 2008. www.nice.org.uk/guidance/index.jsp?action=byID&o=11635 . Last accessed September 2009.
12.
Cappelleri JC, Rosen RCThe Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res2005;17:307-19.
13.
Nice.Identifying and supporting people most at risk of dying prematurely: guidance. London: NICE, 2008. www.nice.org.uk/PH015/guidance/doc/English. Last accessed September 2009.
14.
Ho CMK , Stoddart M., Walton M. et al. Reference Interval for calculated BAT using the Vermeulen equation. Ann Clin Biochem2006;43389-97.
15.
Feldman HA, Goldstein I., Hatzichristou DG, Krane RJ, McKinlay JBImpotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol1994;151:54-61.
16.
Haffner SM, Shaten J., Stern MP et al. Low levels of sex hormone-binding globulin and testosterone predict the development of non-insulin-dependent diabetes mellitus in men. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Am J Epidemiol1996;143: 889-97.
17.
Selvin E., Feinleib M., Zhang L. et al. Androgens and diabetes in men. Results from the Third National Health and Nutrition Survey (NHANES III). Diabetes Care2007;30;234-8.
18.
Bhasin S., Cunningham GR, Hayes FJ et al. Testosterone therapy in adult men with androgen deficiency syndromes; Endocrine society clinical practice guideline. J Clin Endocrinol Metab2006;91:1995-2010.
19.
Heinemann LAJ , Zimmermann T., Vermeulen A., Thiel C.A new ‘Aging Male’s Symptoms’ (AMS) Rating Scale. Aging Male1999;2:105-14.
Home P., Mant J., Diaz J., Turner C.On behalf of the Guideline Development Group. Management of type 2 diabetes: summary of updated NICE guidance. BMJ2008 ;336:1306-08.
22.
Kapoor D., Clarke S., Stanworth R. et al. The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol2007;156: 595-602.
23.
Romeo JH, Seftel AD, Madhun ZT, Aron DCSexual function in men with diabetes type 2: association with glycemic control . J Urol2000; 163:788-91.
24.
Rhoden EL, Ribeiro EP, Riedner CE et al. Glycosylated haemoglobin levels and the severity of erectile function in diabetic men. BJU Int2005;95:615-17.
25.
Kapoor D., Goodwin E., Channer KS et al. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol2006;154:899-906.
