Correlation Between Testosterone Level And Visceral Fat Area And Metabolism In Male Patients With Type 2 Diabetes Mellitus

Objective:International Diabetes Federation statistics show that the number of diabetic patients in China has reached 140 million,ranking first in the world.Diabetes is a serious threat to human health and consumes a lot of medical resources.The situation of diabetes prevention and treatment is grim.Many studies have shown that hypogonadism and visceral fat obesity are closely related to the occurrence and development of metabolic diseases such as diabetes,metabolic syndrome and cardiovascular disease.The purpose of this study was to investigate the correlation between testosterone level,visceral fat area and metabolic indexes in male patients with type 2 diabetes,and to explore the relationship between sex hormone level and abdominal fat distribution.Methods:A total of 315 male patients with type 2 diabetes mellitus(T2DM)aged 20-70 years who were hospitalized in the Department of Endocrinology of the Second Hospital of Jilin University from April 2021 to July 2022 were selected as subjects.Firstly,with testosterone value of 350ng/dl as the cut point,the subjects were divided into low testosterone group(L-TT group)and normal testosterone group(N-TT group).Secondly,with visceral fat area(VFA)≥ 100cm2 as the diagnostic criteria,the subjects were divided into visceral fat obesity group(H-VFA group)and nonvisceral fat obesity group(N-VFA group).The general clinical data and related biochemical indicators of the patients were collected and compared between groups.Spearman correlation analysis was used to explore the correlation between testosterone level,visceral fat area and various metabolic indicators.Linear regression was used to explore the relationship between sex hormone level and abdominal fat distribution.By drawing the receiver operating characteristic(ROC)curve,the area under the ROC curve(AUC)was calculated to evaluate the diagnostic value of abdominal fat distribution for hypogonadism and sex hormone level for visceral fat obesity.The Youden index was calculated to determine the diagnostic cut-off point and the corresponding sensitivity and specificity.Results:With testosterone value of 350ng/dl as the cut point,the subjects were divided into low testosterone group(L-TT group)and normal testosterone group(N-TT group),and the proportion of L-TT group was 51.75 %.The comparison between groups showed that BMI,WC,SFA,VFA,F-CP,HOMA-IR(C-P),TG,Ch E and UA in L-TT group were higher than those in N-TT group,LH and E2 in L-TT group were lower than those in N-TT group,the differences were statistically significant(P <0.05).There was no significant difference in age,course of disease,SBP,DBP,Hb A1 c,FPG,FSH,PRL,TC,HDL-C,LDL-C,Apo A1,Apo B,ALT,AST,ALP andγ-GGT between the two groups(P > 0.05).Correlation analysis showed that TT level was positively correlated with age,LH and E2,and negatively correlated with BMI,WC,SFA,VFA,SBP,DBP,Hb A1 c,FPG,FC-P,HOMA-IR(C-P),TG,TC,Apo B,ALT,γ-GGT,Ch E and UA(P < 0.05).There was no significant correlation between TT level and duration of diabetes,FSH,PRL,HDL-C,LDL-C,Apo A1,AST and ALP(P > 0.05).With visceral fat area(VFA)≥ 100 cm2 as the diagnostic criteria,the subjects were divided into visceral fat obesity group(H-VFA group)and non-visceral fat obesity group(N-VFA group),and the proportion of visceral obesity group was46.03 %.The comparison between groups showed that the age,course of disease and TT in the H-VFA group were lower than those in the N-VFA group,and the BMI,WC,SBP,DBP,SFA,FC-P,HOMA-IR(C-P),TG,TC,Apo B,ALT,AST,γ-GGT,Ch E and UA in the H-VFA group were higher than those in the N-VFA group,and the differences were statistically significant(P < 0.05).There was no significant difference in Hb A1 c,FPG,FSH,LH,PRL,E2,HDL-C,LDL-C,Apo A1 and ALP between the two groups(P > 0.05).The results of correlation analysis showed that VFA was negatively correlated with diabetes duration and TT,and positively correlated with BMI,WC,SBP,DBP,SFA,Hb A1 c,FPG,FC-P,HOMA-IR(C-P),E2,TG,TC,Apo B,ALT,AST,γ-GGT,Ch E and UA(P < 0.05).There was no significant correlation between VFA and age,FSH,LH,PRL,HDL-C,LDL-C,Apo A1 and ALP(P > 0.05).Linear regression analysis was used to explore the relationship between sex hormone levels and abdominal fat distribution.Linear regression analysis showed that TT was strongly negatively correlated with SFA and VFA.After adjusting for age and BMI,the negative correlation still existed.The SFA-TT relationship(P < 0.001)was stronger than the VFA-TT relationship(P = 0.001).There was no significant correlation between E2 and SFA and VFA.After adjusting TT and age,E2 was positively correlated with SFA and VFA.The relationship between SFA-E2 was stronger than that between VFA-E2,but after further adjusting BMI,the positive correlation between E2 and SFA and VFA disappeared.There was a strong negative correlation between SFA,VFA and TT,but no significant correlation with E2.After adjusting for age and BMI,the negative correlation between TT-SFA and TT-VFA still existed.The results of ROC curve and ROC analysis showed that SFA and VFA had certain diagnostic value for hypogonadism,and there was no significant difference in the diagnostic value of hypogonadism.TT has certain diagnostic value for visceral fat obesity,and E2 has no statistical significance in the diagnosis of visceral fat obesity.Conclusion:1.The prevalence of hypogonadism and visceral obesity in male patients with type 2 diabetes is high.2.The decrease of testosterone level and visceral fat accumulation are closely related to the occurrence and development of metabolic disorders.3.There is a vicious circle between the decrease of testosterone level and the accumulation of abdominal adipose tissue.Abdominal adipose tissue has certain diagnostic value for hypogonadism and testosterone level has certain diagnostic value for visceral obesity.