Cai Xiang, Tian Ye, Wu Tao, Cao Chen-Xi, Li Hong, Wang Kun-Jie
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Asian J Androl. 2014 Jan-Feb;16(1):146-52. doi: 10.4103/1008-682X.122346.
This systematic review was aimed at assessing the metabolic effects of testosterone replacement therapy (TRT) on hypogonadal men with type 2 diabetes mellitus (T2DM). A literature search was performed using the Cochrane Library, EMBASE and PubMed. Only randomized controlled trials (RCTs) were included in the meta-analysis. Two reviewers retrieved articles and evaluated the study quality using an appropriate scoring method. Outcomes including glucose metabolism, lipid parameters, body fat and blood pressure were pooled using a random effects model and tested for heterogeneity. We used the Cochrane Collaboration's Review Manager 5.2 software for statistical analysis. Five RCTs including 351 participants with a mean follow-up time of 6.5-months were identified that strictly met our eligibility criteria. A meta-analysis of the extractable data showed that testosterone reduced fasting plasma glucose levels (mean difference (MD): -1.10; 95% confidence interval (CI) (-1.88, -0.31)), fasting serum insulin levels (MD: -2.73; 95% CI (-3.62, -1.84)), HbA1c % (MD: -0.87; 95% CI (-1.32, -0.42)) and triglyceride levels (MD: -0.35; 95% CI (-0.62, -0.07)). The testosterone and control groups demonstrated no significant difference for other outcomes. In conclusion, we found that TRT can improve glycemic control and decrease triglyceride levels of hypogonadal men with T2DM. Considering the limited number of participants and the confounding factors in our systematic review; additional large, well-designed RCTs are needed to address the metabolic effects of TRT and its long-term influence on hypogonadal men with T2DM.
本系统评价旨在评估睾酮替代疗法（TRT）对患有2型糖尿病（T2DM）的性腺功能减退男性的代谢影响。使用Cochrane图书馆、EMBASE和PubMed进行文献检索。荟萃分析仅纳入随机对照试验（RCT）。两名评价者检索文章并使用适当的评分方法评估研究质量。使用随机效应模型汇总包括葡萄糖代谢、脂质参数、体脂和血压在内的结果，并检验异质性。我们使用Cochrane协作网的Review Manager 5.2软件进行统计分析。确定了5项RCT，包括351名参与者，平均随访时间为6.5个月，这些研究严格符合我们的纳入标准。对可提取数据的荟萃分析表明，睾酮降低了空腹血糖水平（平均差值（MD）：-1.10；95%置信区间（CI）（-1.88，-0.31））、空腹血清胰岛素水平（MD：-2.73；95%CI（-3.62，-1.84））、糖化血红蛋白百分比（MD：-0.87；95%CI（-1.32，-0.42））和甘油三酯水平（MD：-0.35；95%CI（-0.62，-0.07））。睾酮组和对照组在其他结果方面无显著差异。总之，我们发现TRT可以改善患有T2DM的性腺功能减退男性的血糖控制并降低甘油三酯水平。考虑到我们系统评价中的参与者数量有限和混杂因素，需要更多大型、设计良好的RCT来研究TRT的代谢影响及其对患有T2DM的性腺功能减退男性的长期影响。
