Effects of intraperitoneal insulin versus subcutaneous insulin administration on sex hormone-binding globulin concentrations in patients with type 1 diabetes mellitus.
OBJECTIVE
Elevated sex hormone-binding globulin (SHBG) concentrations have been described in patients with type 1 diabetes mellitus (T1DM), probably due to low portal insulin concentrations. We aimed to investigate whether the route of insulin administration, continuous intraperitoneal insulin infusion (CIPII), or subcutaneous (SC), influences SHBG concentrations among T1DM patients.


METHODS
Post hoc analysis of SHBG in samples derived from a randomized, open-labeled crossover trial was carried out in 20 T1DM patients: 50% males, mean age 43 (±13) years, diabetes duration 23 (±11) years, and hemoglobin A1c (HbA1c) 8.7 (±1.1) (72 (±12) mmol/mol). As secondary outcomes, testosterone, 17-β-estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were analyzed.


RESULTS
Estimated mean change in SHBG was -10.3nmol/L (95% CI: -17.4, -3.2) during CIPII and 3.7nmol/L (95% CI: -12.0, 4.6) during SC insulin treatment. Taking the effect of treatment order into account, the difference in SHBG between therapies was -6.6nmol/L (95% CI: -17.5, 4.3); -12.7nmol/L (95% CI: -25.1, -0.4) for males and -1.7nmol/L (95% CI: -24.6, 21.1) for females, respectively. Among males, SHBG and testosterone concentrations changed significantly during CIPII; -15.8nmol/L (95% CI: -24.2, -7.5) and -8.3nmol/L (95% CI: -14.4, -2.2), respectively. The difference between CIPII and SC insulin treatment was also significant for change in FSH 1.2U/L (95% CI: 0.1, 2.2) among males.


CONCLUSIONS
SHBG concentrations decreased significantly during CIPII treatment. Moreover, the difference in change between CIPII and SC insulin therapy was significant for SHBG and FSH among males. These findings support the hypothesis that portal insulin administration influences circulating SHBG and sex steroids.
IsalaDiabetes Centre, Zwolle, The Netherlands.
M
M
Boering
IsalaDiabetes Centre, Zwolle, The Netherlands IsalaDepartment of Internal Medicine, Zwolle, The Netherlands p.r.van.dijk@isala.nl.
P R
PR
van Dijk
DiakonessenhuisDepartment of Internal Medicine, Utrecht, The Netherlands Langerhans Medical Research groupZwolle, The Netherlands.
S J J
SJ
Logtenberg
IsalaDiabetes Centre, Zwolle, The Netherlands Department of General PracticeUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
K H
KH
Groenier
Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
B H R
BH
Wolffenbuttel
Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
R O B
RO
Gans
IsalaDiabetes Centre, Zwolle, The Netherlands Langerhans Medical Research groupZwolle, The Netherlands Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
N
N
Kleefstra
IsalaDiabetes Centre, Zwolle, The Netherlands IsalaDepartment of Internal Medicine, Zwolle, The Netherlands Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
H J G
HJ
Bilo
continuous intraperitoneal insulin infusion; sex hormone-binding globulin; subcutaneous insulin therapy; type 1 diabetes mellitus