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The role of sex hormone-binding globulin (SHBG), testosterone, and other sex steroids, on the development of type 2 diabetes in a cohort of community-dwelling middle-aged to elderly men

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Abstract

Aims

Contrasting findings exist regarding the association between circulating sex hormone-binding globulin (SHBG) and testosterone levels and type 2 diabetes (T2D) in men. We examined prospective associations of SHBG and sex steroids with incident T2D in a cohort of community-dwelling men.

Methods

Participants were from a cohort study of community-dwelling (n = 2563), middle-aged to elderly men (35–80 years) from Adelaide, Australia (the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study). The current study included men who were followed for 5 years and with complete SHBG and sex steroid levels (total testosterone (TT), dihydrotestosterone (DHT) and oestradiol (E2)), but without T2D at baseline (n = 1597). T2D was identified by either self-report, fasting glucose (≥ 7.0 mmol/L), HbA1c (≥ 6.5%/48.0 mmol/mol), and/or prescriptions for diabetes medications. Logistic binomial regression was used to assess associations between SHBG, sex steroids and incident T2D, adjusting for confounders including age, smoking status, physical activity, adiposity, glucose, triglycerides, symptomatic depression, SHBG and sex steroid levels.

Results

During an average follow-up of 4.95 years, 14.5% (n = 232) of men developed new T2D. Multi-adjusted models revealed an inverse association between baseline SHBG, TT, and DHT levels, and incident T2D (odds ratio (OR) = 0.77, 95% CI [0.62, 0.95], p = 0.02; OR 0.70 [0.57, 0.85], p < 0.001 and OR 0.78 [0.63, 0.96], p = 0.02), respectively. However, SHBG was no longer associated with incident T2D after additional adjustment for TT (OR 0.92 [0.71, 1.17], p = 0.48; TT in incident T2D: OR 0.73 [0.57, 0.92], p = 0.01) and after separate adjustment for DHT (OR 0.83 [0.64, 1.08], p = 0.16; DHT in incident T2D: OR 0.83 [0.65, 1.05], p = 0.13). There was no observed effect of E2 in all models of incident T2D.

Conclusions

In men, low TT, but not SHBG and other sex steroids, best predicts the development of T2D after adjustment for confounders.

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Acknowledgements

Authors thank the MAILES investigators for their contributions to the study. Particular thanks are extended to Professor Alicia J. Jenkins and Dr. Andrzej S. Januszewski for all their support. The authors also acknowledge Siemens Healthcare for providing the immunoassay kits for all Immulite assays. Finally, thanks are extended to our participants and their families for their invaluable contributions.

Funding

This work was supported by the National Health and Medical Research Council of Australia (NHMRC Project Grant #627227, 2010–2012).

Author information

Authors and Affiliations

  1. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia

    Prabin Gyawali, Sean A. Martin, Leonie K. Heilbronn, Andrew D. Vincent & Gary A. Wittert

  2. Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia

    Prabin Gyawali, Sean A. Martin, Andrew D. Vincent & Gary A. Wittert

  3. South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia

    Prabin Gyawali, Sean A. Martin, Leonie K. Heilbronn, Andrew D. Vincent, Anne W. Taylor, Robert J. T. Adams & Gary A. Wittert

  4. Population Research and Outcomes Studies, University of Adelaide, Adelaide, SA, Australia

    Anne W. Taylor

  5. The Health Observatory, University of Adelaide, Queen Elizabeth Hospital, Woodville, SA, Australia

    Robert J. T. Adams

  6. Chemical Pathology, SA Pathology, Adelaide, SA, Australia

    Peter D. O’Loughlin

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Contributions

Study concept and design: GW, RA, AT; Acquisition of funding: GW, RA, AT; Acquisition of data: PG, SM; Statistical analysis: PG, SA, AV; Interpretation of data: All authors. Drafting of the manuscript: PG, SA, GW; Critical revision of the manuscript for important intellectual content: All authors. All authors have approved the final article.

Corresponding author

Correspondence to Gary A. Wittert.

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Conflict of interest

LH, AV, AT, and PO have nothing to declare. PG was supported by an Australian Government Research Training Program Scholarship and Freemasons Foundation Centre for Men’s Health HDR supplementary scholarship. SM was supported by a NHMRC Early Career Fellowship. RA has received funding from the ResMed Foundation, and nonfinancial support from Embla Systems, Broomfield, Colorado. GW has received research support for investigator initiated projects from Bayer Schering, Eli Lilly, ResMed Foundation, Itamar, Siemens, Weight watchers, Meat and Livestock Australia; Clinical trials for Roche, Pfizer, Astra Zeneca, Takeda, Boehringer, BMS, Amgen, Johnson & Johnson, MSD, GSK, Lawley; Lecture fees from Roche, AbbVie, Amgen, Novo Nordisk, Merck, and Besins; Paid consultant to Elsevier and Lawley Pharmaceuticals.

Ethical approval

This study complies with the ethical standards outlined in the Australian Code for the Responsible Conduct of Research from the National Health and Medical Research Council. Ethics approval was obtained through the Royal Adelaide Hospital and The Queen Elizabeth Hospital Research Ethics Committees.

Informed consent

Written informed consent was provided by each of the eligible participants, who signed in-clinic

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Gyawali, P., Martin, S.A., Heilbronn, L.K. et al. The role of sex hormone-binding globulin (SHBG), testosterone, and other sex steroids, on the development of type 2 diabetes in a cohort of community-dwelling middle-aged to elderly men. Acta Diabetol 55, 861–872 (2018). https://doi.org/10.1007/s00592-018-1163-6

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