Kabha Maharan, Dana Hadar, Kassem Sameer, Dekel Yoram, Cohen Hilla, Zaina Adnan
Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel.
Endocrinol Diabetes Metab. 2025 Jul;8(4):e70064. doi: 10.1002/edm2.70064.
Hypogonadism is commonly linked to type 2 diabetes mellitus (T2DM), with testosterone replacement therapy (TRT) representing a key treatment option. Sodium glucose cotransporter-2 inhibitors (SGLT-2i) class is part of T2DM management. Both treatments can increase Hct, Hb and RBC levels with a potential risk for secondary erythrocytosis. This study compares Hct, RBC and Hb changes between T2DM patients treated with and without SGLT-2i and TRT for hypogonadism.
Data from Clalit Healthcare Services (2015-2023) was analysed from male T2DM patients with hypogonadism. Mixed linear regression assessed SGLT-2i effects on Hct, Hb and RBC levels, while generalised estimation equations were used to predict the proportion of patients with Hct > 54%.
In total, 5235 male patients met the inclusion criteria, with 3146 in the SGLT-2i (+) group, while 2089 comprised the SGLT-2i (-) group. Mean age was 63.8 ± 11.0 years, mean Hct was 43.3% ± 4.4%, BMI was 30.8 ± 5.2 kg/m and eGFR was 84.9 ± 19.3 mL/min/1.73m. The SGLT-2i (+) group demonstrated a statistically significant increase in Hct, Hb, and RBC after TRT initiation (p < 0.001). While the overall increase in Hct > 54% was not statistically significant after TRT initiation with OR = 1.85 [95% CI 0.96-3.67], p = 0.06. However, in the SGLT2i (+) group, it was significantly higher than for those in the SGLT2i (-) group, OR = 4.85 [95% CI 3.06-7.69], p = 0.02.
SGLT-2i and TRT co-administration are associated with an increased chance of developing secondary erythrocytosis in T2DM. Awareness and potential treatment discontinuation may prevent unnecessary investigations. Frequent monitoring of these parameters is essential.
性腺功能减退通常与2型糖尿病（T2DM）相关，睾酮替代疗法（TRT）是一种关键的治疗选择。钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）类药物是T2DM治疗的一部分。这两种治疗方法均可提高血细胞比容（Hct）、血红蛋白（Hb）和红细胞（RBC）水平，存在继发性红细胞增多症的潜在风险。本研究比较了接受和未接受SGLT-2i及TRT治疗性腺功能减退的T2DM患者的Hct、RBC和Hb变化。
分析了Clalit医疗服务机构（2015 - 2023年）中患有性腺功能减退的男性T2DM患者的数据。混合线性回归评估SGLT-2i对Hct、Hb和RBC水平的影响，而广义估计方程用于预测Hct > 54%的患者比例。
共有5235名男性患者符合纳入标准，其中SGLT-2i（+）组有3146人，SGLT-2i（-）组有2089人。平均年龄为63.8 ± 11.0岁，平均Hct为43.3% ± 4.4%，体重指数（BMI）为30.8 ± 5.2 kg/m²，估算肾小球滤过率（eGFR）为84.9 ± 19.3 mL/min/1.73m²。SGLT-2i（+）组在开始TRT后Hct、Hb和RBC有统计学显著增加（p < 0.001）。虽然开始TRT后Hct > 54%的总体增加无统计学显著性，比值比（OR） = 1.85 [95%置信区间（CI）0.96 - 3.67]，p = 0.06。然而，在SGLT2i（+）组中，该比例显著高于SGLT2i（-）组，OR = 4.85 [95% CI 3.06 - 7.69]，p = 0.02。
SGLT-2i与TRT联合使用与T2DM患者发生继发性红细胞增多症的几率增加有关。提高认识并可能停用治疗可避免不必要的检查。定期监测这些参数至关重要。
