Lancet子刊:睾酮或能治疗男性2型糖尿病?!

2021-01-10 MedSci原创 MedSci原创

除了通过健康饮食和增加活动来实现适度的体重减轻之外,睾丸激素对预防或逆转新诊断的T2DM有一些额外的好处。

对于成年性腺功能减退症患者,外源性睾酮疗法(TTh)因能提高血清睾酮(T)水平,是目前使用最为广泛的疗法。然而,有研究表明,TTh可能会影响AOH患者的血管(CV)风险因素,且低内源性T水平与CV风险和死亡率的增加有关。

为此,20201月,美国医师协会(ACP)发布了成年男性年龄相关性低睾酮水平的睾酮治疗指南,ACP专家组主要基于最新的证据针对成年男性年龄相关性低睾酮水平的睾酮治疗提出指导建议。

2糖尿病T2DM)原名叫成人发病型糖尿病,多在35~40岁之后发病,占糖尿病患者90%以上。T2DM患者体内产生胰岛素的能力并非完全丧失,有的患者体内胰岛素甚至产生过多,但胰岛素的作用效果较差,因此患者体内的胰岛素是一种相对缺乏,可以通过某些口服药物刺激体内胰岛素的分泌。

Diabetes Care. 2019 Jun;42(6):1104-1111. doi: 10.2337/dc18-2388.

其中,糖尿病前期阶段为预防T2D发生发展提供了干预窗口。据统计,T2DM和糖尿病前期的男性患者通常具有较低的睾酮水平。此外,超重或肥胖的男性经常有血清睾酮浓度低的情况,这与T2DM的风险增加也密切相关。

由于睾酮能改善T2DM的血糖控制,因此研究人员十分关心TTh是否能阻止性腺功能低下的糖尿病前期患者疾病进展到T2DM阶段。2019312日在线发表于Diabetes Care杂志上的研究表明,TTh完全阻止了男性性腺功能减退和糖尿病前期患者发展到T2DM阶段。

那么,TTh是否能预防或逆转T2DM呢?为此,来自澳大利亚的研究人员展开了一项名为T4DM(睾酮预防糖尿病)的研究。相关结果发表在《柳叶刀子刊》Lancet Diabetes Endocrinology杂志上。

T4DM是一项随机、双盲、安慰剂对照、为期2年的3b期试验,在澳大利亚6个三级医疗中心完成。共纳入1000多名年龄在50-74岁、腰围95cm以上、血清睾酮浓度14-0nmol/L或更低,但无病理性性腺功能减退、糖耐量受损(口服葡萄糖耐量试验[OGTT]2-h葡萄糖7-8-11-0mmol/L)或新诊断T2DM(前提是OGTT 2-h葡萄糖≤15-0mmol/L)的男性。

对上述参与者均进行生活方式干预,同时进行11随机分配,分别接受肌肉注射十一酸睾酮(1000 mg)或安慰剂。经过两年的治疗,安慰剂组413名受试者中有87名(21%)发生糖尿病,而睾酮组443名受试者中仅有55名(12%)发生糖尿病。两组受试者体重平均减轻3~4 kg

结果在2年的随访中,安慰剂组与睾酮组分别有87/413(21%)和55/443(12%)参与者的2-h OGTT达到11-1 mmol/L或更高(相对风险0.59)。与基线相比,安慰剂组2-h OGTT平均变化为-0.95 mmol/L,睾酮组为-1.70 mmol/L。同时,治疗效果与基线血清睾酮无关。

此外,与安慰剂组相比,服用睾酮治疗两年后的受试者患者的空腹血糖较低,体脂大幅减少,骨骼肌质量和握力增加,在生活质量上没有差别。

该研究结果表明,除了通过健康饮食和增加活动来实现适度的体重减轻之外,睾丸激素对预防或逆转新诊断的T2DM有一些额外的好处。当然,鉴于有T2DM风险的男性通常体重过重,或者有其他慢性疾病的风险,因此研究者指出,通过健康的生活方式实现的减肥仍然是主要措施。

 

参考文献:

Wittert G, et al. Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): a randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. Lancet Diabetes Endocrinol. 2021 Jan;9(1):32-45. doi: 10.1016/S2213-8587(20)30367-3.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1830982, encodeId=11be183098255, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Dec 17 03:05:30 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915541, encodeId=ef2c915541ea, content=女性多囊?睾酮高,二型糖尿病高发啊?难倒睾酮对男女不一样?, beContent=null, objectType=article, channel=null, level=null, likeNumber=221, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=41db5120163, createdName=14633a58m77暂无昵称, createdTime=Mon Jan 11 11:44:10 CST 2021, time=2021-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915406, encodeId=b39491540611, content=<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>阴阳两虚吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jan 10 22:50:53 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034127, encodeId=0449103412ef9, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043457, encodeId=69d5104345e97, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=)]
    2021-12-17 howi
  2. [GetPortalCommentsPageByObjectIdResponse(id=1830982, encodeId=11be183098255, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Dec 17 03:05:30 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915541, encodeId=ef2c915541ea, content=女性多囊?睾酮高,二型糖尿病高发啊?难倒睾酮对男女不一样?, beContent=null, objectType=article, channel=null, level=null, likeNumber=221, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=41db5120163, createdName=14633a58m77暂无昵称, createdTime=Mon Jan 11 11:44:10 CST 2021, time=2021-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915406, encodeId=b39491540611, content=<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>阴阳两虚吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jan 10 22:50:53 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034127, encodeId=0449103412ef9, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043457, encodeId=69d5104345e97, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=)]
    2021-01-11 14633a58m77暂无昵称

    女性多囊?睾酮高,二型糖尿病高发啊?难倒睾酮对男女不一样?

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1830982, encodeId=11be183098255, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Dec 17 03:05:30 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915541, encodeId=ef2c915541ea, content=女性多囊?睾酮高,二型糖尿病高发啊?难倒睾酮对男女不一样?, beContent=null, objectType=article, channel=null, level=null, likeNumber=221, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=41db5120163, createdName=14633a58m77暂无昵称, createdTime=Mon Jan 11 11:44:10 CST 2021, time=2021-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915406, encodeId=b39491540611, content=<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>阴阳两虚吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jan 10 22:50:53 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034127, encodeId=0449103412ef9, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043457, encodeId=69d5104345e97, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=)]
    2021-01-10 lovetcm

    #糖尿病#阴阳两虚吧

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1830982, encodeId=11be183098255, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Dec 17 03:05:30 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915541, encodeId=ef2c915541ea, content=女性多囊?睾酮高,二型糖尿病高发啊?难倒睾酮对男女不一样?, beContent=null, objectType=article, channel=null, level=null, likeNumber=221, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=41db5120163, createdName=14633a58m77暂无昵称, createdTime=Mon Jan 11 11:44:10 CST 2021, time=2021-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915406, encodeId=b39491540611, content=<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>阴阳两虚吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jan 10 22:50:53 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034127, encodeId=0449103412ef9, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043457, encodeId=69d5104345e97, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=)]
    2021-01-10 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1830982, encodeId=11be183098255, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Dec 17 03:05:30 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915541, encodeId=ef2c915541ea, content=女性多囊?睾酮高,二型糖尿病高发啊?难倒睾酮对男女不一样?, beContent=null, objectType=article, channel=null, level=null, likeNumber=221, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=41db5120163, createdName=14633a58m77暂无昵称, createdTime=Mon Jan 11 11:44:10 CST 2021, time=2021-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=915406, encodeId=b39491540611, content=<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>阴阳两虚吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=227, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jan 10 22:50:53 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034127, encodeId=0449103412ef9, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043457, encodeId=69d5104345e97, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Jan 10 17:05:30 CST 2021, time=2021-01-10, status=1, ipAttribution=)]
    2021-01-10 misszhang

    谢谢MedSci提供最新的资讯

    0