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,与预后有关。对非 (CHF) 男性睾丸激素的研究表明,生理性睾丸激素疗法可改善胰岛素敏感性。这是一项单盲安慰剂对照交叉试验,用于确定睾丸激素替代对13名中度至重度CHF (射血分数30.5 +/-1.3) 男性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数 (homa-ir),次要结果是通过生物电阻抗和葡萄糖耐量对标准75g口服葡萄糖负荷进行测量的身体成分。对安慰剂与睾丸激素相比的治疗效果的delta值进行了分析。在基线时,homa-ir与体脂 [% 脂肪质量 (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严重程度无关。睾酮降低homa-ir (-1.9 +/-0.8,p = 0.03),表明改善的空腹胰岛素敏感性。睾酮也增加总质量 (+ 1.5 +/-0.5千克,p = 0.008) 和减少体脂 (-0.8 +/-0.3%,p = 0.02)。睾丸激素可改善CHF男性的空腹胰岛素敏感性,也可能增加瘦体重,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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