Association Between Androgen Deprivation Therapy and Deterioration of Glycemic Control and Cardiovascular Risk Factors in Men with Type 2 Diabetes Mellitus
Saad, F(1, 2); Aksam, Y(3, 4); Haider, A(5)
(1)Male Healthcare, Bayer Schering Pharma, Berlin, Germany (2)Research Dept., Gulf Medical College School of Medicine, Ajman/UAE (3)Segeberger Kliniken, Norderstedt-Hamburg / Germany (4)Department of Urology, Gulf Medical College School of Medicine, Ajman / UAE (5)Urology office, Bremerhaven, Germany
Objective: To determine the effects of administration of gonadotrophin releasing hormone (GnRH) agonists on glycemic control and cardiovascular risk factors in 29 men with Type 2 diabetes mellitus. Methods: This is a retrospective analysis of 29 male patients diagnosed initially with Type 2 diabetes mellitus prior to a subsequent diagnosis of prostate cancer being made. Patients were being treated for type 2 diabetes with insulin, and for prostate cancer with androgen deprivation therapy via administration of various GnRH agonists. The following clinical parameters were retrospectively obtained from patient records over a period of up to 24 months on androgen deprivation therapy: Fasting glucose, glycosylated hemoglobin (HbA1c), total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), C-reactive protein (CRP) and insulin requirement. Results: Over the analysis period, fasting glucose increased from 143.2 ± 26.8 to 187.3 ± 30.2 mg/dL requiring an increase in the insulin dosage from 26.1 ± 7.2 to 48.2 ± 9.9 U/day. HbA1c levels rose from 6.3 ± 1.0 % to 9.3 ± 1.2 %. The levels of a number of cardiovascular risk factors deteriorated: CRP from 1.3 ± 0.5 to 2.3 ± 0.6 mg/dL, total cholesterol from 252.0 ± 41.1 to 322.3 ± 41.1 mg/dL, HDL-C from 31.4 ± 6.3 to 20.9 ± 2.2 mg/dL, LDL-C from 184.5 ± 16.3 to 229.1 ± 21.0 mg/dL, triglycerides from 207.4 ± 39.3 to 283.9 ± 49.7 mg/dL, fibrinogen from 3.0 ± 1.1 to 13.0 ± 0.6 g/L (data from 13 patients), PAI-1 from 36.9 ± 7.6 to 69.0 ± 14.0 m/L (data from 6 patients), and t-PA from 124.9 ± 36.2 to 185.7 ± 22.3 % (data from 6 patients). Conclusion: In insulin-treated patients with Type 2 diabetes mellitus, androgen deprivation therapy with GnRH agonists may have profound negative effects on glycemic control and increase the risk of development of cardiovascular disease.
