Resistance to insulin occurs in chronic heart failure (CHF) and is related to prognosis. Studies of testosterone in non-(CHF) males suggest that physiological testosterone therapy improves insulin sensitivity. This was a single-blind placebo controlled crossover trial to determine the effect of testosterone replacement on insulin sensitivity in 13 men with moderate to severe CHF (ejection fraction 30.5+/-1.3). The primary outcome was the homeostatic model index (HOMA-IR) of fasting insulin sensitivity and secondary outcomes were body composition as measured by bioelectrical impedance and glucose tolerance to a standard 75 g oral glucose load. Analysis was performed on the delta values with the treatment effect of placebo compared with that of testosterone. At baseline HOMA-IR correlated with measures of body fat [% fat mass (rP=0.84, p=0.0001) and body mass index (rP=0.79, p=0.01)] but not with CHF severity. Testosterone reduced HOMA-IR (-1.9+/-0.8, p=0.03) indicating improved fasting insulin sensitivity. Testosterone also increased total mass (+1.5+/-0.5 kg, p=0.008) and decreased body fat (-0.8+/-0.3%, p=0.02). Testosterone improves fasting insulin sensitivity in men with CHF and may also increase lean body mass, these data suggest a favourable effect of testosterone on an important metabolic component of CHF.

译文

胰岛素抵抗发生在慢性心力衰竭(CHF)中,并与预后有关。非(CHF)男性中睾丸激素的研究表明,生理性睾丸激素疗法可提高胰岛素敏感性。这是一项单盲安慰剂对照的交叉试验,旨在确定睾丸激素替代对13例中度至重度CHF(射血分数30.5 /-1.3)男性的胰岛素敏感性的影响。主要结果是空腹胰岛素敏感性的稳态模型指标(HOMA-IR),次要结果是通过生物电阻抗和对标准75 g口服葡萄糖负荷的葡萄糖耐量测得的身体成分。分析了δ值,比较了安慰剂和睾丸激素的治疗​​效果。基线时,HOMA-IR与体脂[脂肪含量%(rP = 0.84,p = 0.0001)和体重指数(rP = 0.79,p = 0.01)]的测量值相关,但与CHF严重度无关。睾丸激素降低HOMA-IR(-1.9 /-0.8,p = 0.03),表明空腹胰岛素敏感性提高。睾丸激素还增加了总质量(1.5 /-0.5 kg,p = 0.008),减少了体内脂肪(-0.8 /-0.3%,p=0.02)。睾丸激素改善患有CHF的男性的空腹胰岛素敏感性,还可能增加瘦体重,这些数据表明睾丸激素对CHF的重要代谢成分具有有利作用。

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