Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Endocrinology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
Front Endocrinol (Lausanne). 2022 Jul 19;13:894743. doi: 10.3389/fendo.2022.894743. eCollection 2022.
Our previous study has found that short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM) increased serum testosterone levels, but the underlying mechanisms remain unclear.
In this self-controlled study, 43 men with newly diagnosed drug naïve T2DM, aged 18-60 years, with HbA9.0% were treated with continuous subcutaneous insulin infusion (CSII) to normalize blood glucose within one week. Venous blood specimens were collected for measuring of serum total testosterone, dehydroepiandrosterone sulfate (DHEA-S), 3β- and 17β-hydroxysteroid dehydrogenase (3β- and 17β-HSD) concentrations before and after insulin therapy.
Testosterone increased from 13.0 (11.3, 14.6) nmol/L to 15.7 (13.9, 17.5) nmol/L after intensive insulin therapy (<0.001), while the levels of DHEA-S decreased significantly after treatment (from 6.5 (5.7, 7.3) μmol/L to 6.0 (5.3, 6.7) μmol/L, =0.001). The ratio of testosterone/DHEA-S increased significantly (2.4 (2.0, 2.8) vs. 3.1 (2.6, 3.7) nmol/μmol, <0.001). After blood glucose normalization with the short-term CSII therapy, 3β-HSD increased from 11.0 (9.5, 12.5) pg/mL to 14.6 (13.5, 15.7) pg/mL, =0.001, and 17β-HSD increased from 20.7 (16.3, 25.2) pg/mL to 28.2 (23.8, 32.5) pg/mL, =0.009.
Blood glucose normalization short-term intensive insulin therapy increases plasma total testosterone levels in men with newly diagnosed type 2 diabetes, associated with a decreased level of DHEA-S, probably because of the enhanced conversion from DHEA to testosterone catalyzed by 3β-HSD and 17β-HSD.
我们之前的研究发现，新诊断的 2 型糖尿病（T2DM）患者接受短期强化胰岛素治疗后，血清睾酮水平升高，但具体机制尚不清楚。
在这项自身对照研究中，43 名年龄在 18-60 岁、新诊断且未服用药物的 T2DM 男性患者，HbA9.0%，接受持续皮下胰岛素输注（CSII）治疗，在一周内将血糖控制正常。在胰岛素治疗前后采集静脉血样，检测血清总睾酮、硫酸脱氢表雄酮（DHEA-S）、3β-和 17β-羟类固醇脱氢酶（3β-和 17β-HSD）浓度。
强化胰岛素治疗后，睾酮从 13.0（11.3，14.6）nmol/L 增加到 15.7（13.9，17.5）nmol/L（<0.001），而 DHEA-S 水平在治疗后显著降低（从 6.5（5.7，7.3）μmol/L 降至 6.0（5.3，6.7）μmol/L，=0.001）。睾酮/DHEA-S 比值显著升高（2.4（2.0，2.8）比 3.1（2.6，3.7）nmol/μmol，<0.001）。在短期 CSII 治疗使血糖正常化后，3β-HSD 从 11.0（9.5，12.5）pg/mL 增加到 14.6（13.5，15.7）pg/mL，=0.001，17β-HSD 从 20.7（16.3，25.2）pg/mL 增加到 28.2（23.8，32.5）pg/mL，=0.009。
新诊断的 2 型糖尿病男性患者短期强化胰岛素治疗使血糖正常化后，血浆总睾酮水平升高，同时 DHEA-S 水平降低，可能是由于 3β-HSD 和 17β-HSD 催化 DHEA 向睾酮转化增强所致。
