Type 2 diabetes (diabetes) is an increasingly common problem. When present it reduces overall quality of life and increases the risks for heart attacks and strokes, loss of sexual function, troublesome urinary symptoms, loss of cognitive function and even dementia, kidney failure, blindness, painful foot and leg problems and many cancers. The health care costs to treat people with diabetes are high.
Over 20 years there has been a threefold increase in the number of people with diabetes. In 2007-2008 it was estimated that 4.1% of the Australian population had diabetes (not all, but mostly type 2 diabetes). An equivalent number are affected but have not yet been diagnosed. The longer the delay to diagnosis the more damage occurs, and the lower the likelihood of being able to manage the disease totally to prevent these complications.
Type 2 diabetes tends to run in families. The likelihood of developing the disease increases with increasing age and it is more common in men than women in Australia. Most importantly, we know that the onset of diabetes is strongly related to obesity particularly when the excess body fat is around the belly. Because of the obesity epidemic, here in Australia, we are now seeing type 2 diabetes occurring in younger people; alarmingly even in children and adolescents.
Beginning in 2002 and again five years later, we determined the number of men over the age of 35, living in the north-western suburbs of Adelaide, who had diabetes. In 2002 13% of the men had diabetes and five years later 19% of the men had diabetes. This is a dramatic increase over a relatively short time span. We found that the men at particular high risk for developing diabetes or progressing from pre-diabetes to full diabetes were aged 50 or more, had a waist circumference over 95 cm, and a low level of the main male sex hormone, called testosterone.
There are a number of reasons why a low testosterone level might increase the risk of developing diabetes. Testosterone decreases fat mass, increases muscle mass, improves metabolism, and perhaps arguably of most importance it may increase motivation to improve lifestyle.
A lifestyle program with diet and physical activity resulting in 7% weight loss can prevent up to 60% of cases of type 2 diabetes developing over three years. But it is difficult to get people, men in particular, to engage in such programs. We wondered, therefore, whether the use of testosterone supplements might have benefit.
In a world first, we proposed that given the potential beneficial effects of testosterone, supplementing the levels of testosterone in men with low levels may prevent progression to diabetes. This possibility has never been tested. The National Health and Medical Research Council also thought that it was an important question and provided us with funding to answer the question. We seek to enrol a total of 1500 overweight or obese men, aged 50 and over with low blood testosterone levels and a high risk of developing diabetes over the 2 year treatment period of the trial. At least 250 men will be enrolled in Adelaide. There are other centres in Melbourne, Perth, and Sydney.
More information can be obtained on the website www.T4DM.org.au or by calling 82226081. You can also follow us on twitter @T4DM.
This is an opportunity to prevent diabetes and therefore the associated complications and improve overall quality and enjoyment of life.