Steroids in Adult Men With Type 1 Diabetes
A tendency to hypogonadism
- Eveline W.C.M. van Dam, MD12,
- Jacqueline M. Dekker, PHD3,
- Eef G.W.M. Lentjes, MD, PHD4,
- Fred P.T.H.M. Romijn4,
- Yvo M. Smulders, MD, PHD2,
- Wendy J. Post5,
- Johannes A. Romijn, MD, PHD1 and
- H. Michiel J. Krans, MD, PHD1
- 1Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
- 2Department of Internal Medicine, VU Medical Centre, Amsterdam, the Netherlands
- 3Institute for Research and Medicine, VU Medical Centre, Amsterdam, the Netherlands
- 4Department of Clinical Chemistry, Leiden University Medical Center, Leiden, the Netherlands
- 5Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
Abstract
OBJECTIVE—To compare steroids and their associations in men with type 1 diabetes and healthy control subjects.
RESEARCH DESIGN AND METHODS—We studied 52 adult men with type 1 diabetes without microvascular complications, compared with 53 control subjects matched for age and BMI. Steroids and their binding globulins were assessed in a single venous blood sample and a 24-h urine sample.
RESULTS—In adult men with type 1 diabetes, total testosterone did not differ from healthy control subjects, but sex hormone–binding globulin (SHBG) (42 [14–83] vs. 26 [9–117] nmol/l, P < 0.001), cortisol-binding globulin (CBG; 0.87 ± 0.17 vs. 0.73 ± 0.10 nmol/l, P < 0.001), and cortisol levels (0.46 ± 0.16 vs. 0.39 ± 0.14 nmol/l, P < 0.01) were higher. The free testosterone index was lower (60 [17–139] vs. 82 [24–200], P < 0.001), and the calculated free testosterone was slightly lower (497 [115] vs. 542 [130], P < 0.064), but the pituitary-gonadal axis was not obviously affected in type 1 diabetes. The calculated free serum cortisol was not different, and 24-h urinary free cortisol excretion was lower in type 1 diabetes (121 [42–365] vs. 161 [55–284] nmol/24 h, P < 0.009). Testosterone was mainly associated with SHBG. Estimated portal insulin was a contributer to SHBG in control subjects but not in type 1 diabetes. Cortisol was associated with CBG. HbA1c contributed to CBG in men with diabetes but not in control subjects, whereas estimated portal insulin did not contribute.
CONCLUSIONS—Adult men with fairly controlled type 1 diabetes without complications who are treated with subcutaneous insulin have a tendency to hypogonadism, as reflected by lower free testosterone levels in the presence of similar total testosterone levels and higher SHBG levels.
- CBG, cortisol-binding globulin
- DHEA, dehydroepiandrosterone
- DHEAS, DHEA-sulfate
- FSH follicle-stimulating hormone
- LH, luteinizing hormone
- SHBG, sex hormone–binding globulin
- WHR, waist-to-hip ratio
Footnotes
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Address correspondence and reprint requests to Eveline W.C.M. van Dam, Department of Internal Medicine 4 a 19, Vrije Universiteit Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: ew.vandam{at}vumc.nl.
Received for publication 4 October 2002 and accepted in revised form 5 March 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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