Prediabetes May Pose Threat to Male Fertility | Lark Health

Prediabetes May Pose Threat to Male Fertility

Prediabetes May Pose Threat to Male Fertility

Infertile men with prediabetes showed lower testosterone, sex hormone-binding globulin levels

by Kristen Monaco, Staff Writer, MedPage Today October 19, 2018

Prediabetes among men might be related to infertility, a new study suggested.

In a cohort of 744 men with primary infertility, around 15% fit the criteria for having undiagnosed prediabetes, reported Andrea Salonia, MD, PhD, of the University Vita-Salute San Raffaele in Milan, Italy, and colleagues.

"We decided to conduct this study because while previous reports have shown that diabetes mellitus is associated with impaired semen parameters, nuclear DNA fragmentation rates, and chromatin quality, very little is known about the same association with prediabetes," the study's first author, Luca Boeri, MD, of the University of Milan, told MedPage Today.

"Moreover prediabetes is a common and underdiagnosed clinical condition that can be considered a red flag for further metabolic and cardiovascular diseases. Infertility per se is nowadays considered as a proxy of the overall male health,," he said.

Writing in BJU International, the researchers reported elevated median hormonal markers among infertile men, including follicle-stimulating hormone (FSH) and 17β-estradiol (E2), compared with infertile men without prediabetes (interquartile ranges in parentheses):

  • FSH: 6.2 mUI/mL (3.9-20.0) [prediabetes] versus 4.9 mUI/mL (2.9-9.1; P<0.001)

  • E2: 30.0 pg/mL (24-41.5) vs 25.0 pg/mL (24-34; P=0.03)

In addition, medians for several other hormonal markers were significantly lower among infertile men with prediabetes compared with infertile men who had normal glucose levels (interquartile ranges in parentheses)

  • Total testosterone: 3.7 ng/mL (2.9-5.3) [prediabetes] versus 4.5 ng/mL (3.4-5.7; P<0.01)

  • Sex hormone-binding globulin: 30.7 nmol/L (24.7-40) versus 33.1 nmol/L (25.1-43.8; P=0.035)

  • Inhibin B: 73.9 pg/mL (16.9-140.5) versus 116.8 pg/mL (60.5-167.3; P=0.001)

Despite similar sperm concentrations and semen volumes between the two groups, significantly more men with prediabetes also had sperm DNA fragmentation over the threshold of 30% (58.4% prediabetes versus 41.8%, P=0.005), the researchers reported.

For the analysis, they used the American Diabetes Association's criteria for prediabetes, defined as a fasting plasma glucose level of 100-125 mg/dL, a 2-hour, 75 g oral glucose tolerance test of 140-199 mg/dL, or an HbA1c of 5.7-6.4%.

Boeri said that although this was the first study to look at the link between prediabetes and male infertility, the findings were not especially surprising -- mainly due to the known relationship between hyperinsulinemia and androgen deficiency.

"Interestingly enough, we also found that semen parameters -- in terms of volume, count, motility and morphology -- did not differ according to the glycemic status," he explained, adding that "speculatively, we could hypothesize that these counterintuitive findings could be explained through the various evidences that testes develop glucose adaptive metabolic mechanisms to ensure an adequate microenvironment for germ cells development."

Boeri said that he recommends that clinicians assess glucose levels in male patients with infertility problems and recognize the clinical importance of prediabetes. By identifying prediabetes early, this will allow "the possible countermeasures to be taken as early as possible in relatively young persons," he said.

Boeri and co-authors reported having no disclosures.

LAST UPDATED 10.19.2018






How to Reverse Prediabetes | Lark Health

How to Reverse Prediabetes

What Is Prediabetes and How do you Reverse It?

Prediabetes the stage before Diabetes. It is a condition in which your blood sugar is higher than normal, but not as high as it would be if you had diabetes.  If you have prediabetes, you may have no symptoms. However, you are at higher risk for developing diabetes. If you get diabetes, you will need to manage it with steps such as taking your blood sugar multiple times a day and using medications, possibly including insulin injections, and other costly and dramatic lifestyle changes if you want to prevent complications and early death.

How Many People Have Prediabetes and is it Reversible?

Prediabetes is increasingly common. More than 1 out of 3 American adults have it, totaling about 84 million, according to the Centers for Disease Control and Prevention (CDC). Of these, nearly 9 out of 10 do not know they have it, making them more vulnerable to diabetes since they are not working on reversing their prediabetes.

Take the 1 Minute Quiz to See If You Are At Risk and How to Reverse It

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Reversing Prediabetes

If you have prediabetes, you can reverse it by making lifestyle changes that help you lose extra weight, increase your physical activity levels, and make dietary change to improve cholesterol levels and lower blood pressure.

If you are overweight, losing even a small amount of weight can help you reverse your prediabetes. Research has found that for every kilogram (2.2 pounds) of extra body weight you lose, your risk for diabetes decreases by an impressive 16%. While losing weight is not easy, it may be more doable when you set smaller goals such as a few pounds at a time.

Even small changes to your diet can help you lose weight and reverse prediabetes. Consider these strategies – which can also help you lower blood pressure, improve cholesterol, and lower triglycerides:

  • Eating more vegetables at meals and for snacks.

  • Swapping fatty red meat for lean cuts, skinless poultry, fish, egg whites, and beans.

  • Choosing water or decaffeinated black coffee or plain tea instead of soft drinks, energy drinks, and other sugar-sweetened beverages.

  • Choosing whole grains instead of refined, fruit instead of sugar-sweetened dessert, and olive oil instead of butter.

You can also consider how you prepare and eat your food. These habits can help you lose weight and reduce other risk factors for diabetes.

  • Baking, grilling, steaming, and roasting instead of frying.

  • Serving yourself smaller portions of high-sugar, high-fat, and high-carbohydrate foods.

  • Cooking for yourself instead of eating out.

The CDC recommends getting at least 150 minutes per week of moderate-intensity physical activity, or at least 30 minutes on most days of the week. You can break up your 30 daily minutes into 3 10-minute sessions, if you prefer or if you do not have time for a single 30-minute session during the day.

Examples of moderate-intensity physical activity include:

  • Walking briskly.

  • Water aerobics.

  • Leisurely cycling.

  • Playing doubles tennis.

  • Roller skating.

  • Gardening and mowing the lawn.

You could alternatively do 75 minutes per week of vigorous-intensity physical activity, or hit your goals with a combination of moderate and vigorous exercises.

Examples of vigorous-intensity physical activity include:

  • Running.

  • Bicycling uphill or fast.

  • Swimming laps.

  • Kickboxing.

  • Circuit strength training.

  • Playing soccer or singles tennis.

There are other changes you can make to lead a healthier lifestyle. Reducing and managing stress can lower inflammation and slow the progression of insulin resistance. The importance of getting enough sleep is often overlooked, but even short periods of sleep deprivation can increase insulin resistance. Quitting smoking can also support healthier blood sugar levels.


Prediabetes A1C Range

As you start to learn about prediabetes reversal, you may see a lot of references to “A1C” or the “A1C test.” The term “A1C” is short for “HbA1C,” which refers to “glycated hemoglobin.” Your glycated hemoglobin, or A1C, is the percent of hemoglobin in your body that has been glycated – but here is a breakdown.

  • “Hemoglobin” is the type of protein that carries oxygen in your red blood cells. It delivers the oxygen to the cells in your body as your blood circulates.

  • “Glycated” means that a sugar, or glucose, molecule, is attached. The glycation (or glycosylation) process can occur when there is too much sugar in your blood – that is, when blood sugar levels are high.

Glycated hemoglobin, or A1C, is a measure of how high your blood sugar has been over the past two to three months. A “normal” value is under 5.7%, while a value of 5.7 to 6.4% is considered to be prediabetes. A higher value than that is indicative of diabetes.

Prediabetes Test Online

The online prediabetes test is located on the CDC’s website, and it takes only a minute to complete. First, answer the 7 yes/no questions.

  1. Are you a woman who has had a baby weighing more than 9 pounds at birth?

  2. Do you have a sister or brother with diabetes?

  3. Do you have a parent with diabetes?

  4. Find your height on the chart. Do you weigh as much as or more than the weight listed for your height?

  5. Are you younger than 65 years of age and get little or no exercise in a typical day?

  6. Are you between 45 and 64 years of age?

  7. Are you 65 years of age or older?


Scoring Your Online Prediabetes Test

Next, see how many points you got for each question. You get 0 points for a question if your answer was, “No.” If you answered, “Yes,” you get the following numbers of points.

Question Point Description
Are you a woman who has had a baby weighing more than 9 pounds at birth?
A high birth weight can mean that that mother had some trouble controlling blood sugar during pregnancy. From this question, you can see that this can put you at risk for prediabetes even after pregnancy.
Do you have a sister or brother with diabetes?
This question lets you know that prediabetes has at least a small genetic component – it can run in families.
Do you have a parent with diabetes?
Again, this is a question that considers your genetic risk. If your mother or father had diabetes, they could have passed down the higher risk of it to you.
Find your height on the chart. Do you weigh as much as or more than the weight listed for your height?
This question gets at your weight, since extra body weight increases your risk for prediabetes. The chart that the question refers to shows you the weights corresponding to a BMI of 25 or over for your height – that is the BMI that is considered to be at risk for most people (for Pacific Islanders, the at-risk BMI is 26 or over, and for Asian Americans, the at-risk BMI is 23 or over).
Are you younger than 65 years of age and get little or no exercise in a typical day?
Exercise is important for keeping your blood sugar levels under control. Even if you are not over 65 years, old, being physically inactive gives you an increased risk for prediabetes.
Are you between 45 and 64 years of age?
Your body’s ability to control your blood sugar tends to decrease as you get older, so being over 45 years old increases your risk for prediabetes.
Are you 65 years of age or older?
The older you get, the higher your risk for prediabetes because of poorer blood sugar control. Still, the reason why your body may tend to have more trouble keeping down blood sugar may not be so much related to “aging” as to the tendency to have more body fat and less lean muscle mass as you get older. This means that you can lower your risk by losing extra weight to lower body fat, and exercising to increase muscle mass.

Then, add up the points you received on each question to get a total score.

Online Prediabetes Test Results

If your score is 0 to 2, that is great! It means you probably do not have prediabetes right now. Now is a good time to think about what you can do now to keep your risk low in the future. You can consider making sure you eat plenty of healthy foods, avoid too many sugary and fatty foods, and get regular physical activity if you do not already exercise.

If your score is 3 to 8, your chance of having prediabetes right now are low, according to the CDC. What you can try to do now is to keep your risk low. Try to keep your weight below the healthy cut-off, or lose excess weight if you are above that number. You can also work on eating a healthier diet with plenty of nutritious foods, such as vegetables, whole grains, and plant-based proteins. Getting more exercise can help you stay healthy, too, as long as your healthcare provider approves.

If your score is 9 points or over, you have a high risk of having prediabetes now. The CDC recommends that you talk to your healthcare provider. You can get a test to see if you have prediabetes.

Test for Prediabetes

The options that you have when you test for prediabetes depend on your health care coverage. You can ask your primary health care provider how to get tested. If you have individual or group insurance through your employer, you may have to pay a copay or hit your deductible. If you do not have insurance, you may need to pay out of pocket, but a glucose test can be relatively inexpensive. Medicaid may cover your test, and Medicare will cover it if your provider provides a reason why you need the test.

A test for prediabetes is easy and fast. All you need is a simple blood draw to get a fasting blood sugar test or to test your A1C levels. An oral glucose tolerance test (OGTT) can take up to a few hours. You will need to stop eating the night before your test if it is a fasting test or OGTT. Your results can come within a day or a couple of weeks, depending on the lab and your healthcare provider.

Online Diabetes Prevention Programs May be Covered by Insurance

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