Background:While previous studies have demonstrated testosterone's beneficial effects on glycemic control in men with hypogonadism and Type 2 Diabetes, the extent to which these improvements are observed based on the degree of treatment adherence has been unclear.Objectives: To evaluate the effects of long-term testosterone therapy in A1C levels in men with Type 2 Diabetes Mellitus and hypogonadism, controlling for BMI, pretreatment A1C, and age among different testosterone therapy adherence groups. Materials and methods:We performed a retrospective analysis of 1737 men with diabetes and hypogonadism on testosterone therapy for 5 years of data from 2008-2018, isolating A1C, lipid panels, and BMI results for analysis. Subjects were categorized into adherence groups based on quartiles of the proportion of days covered (> 75% of days, 51-75% of days, 26-50% of days and 0-25% of days), with >75% of days covered considered adherent to therapy.Results: Pre-treatment median A1C was 6.8%. Post-treatment median A1C was 7.1%.The adherent group, >75%, was the only group notable for a decrease in A1C, with a median decrease of −0.2 (p = 0.0022). BMI improvement was associated with improved post-treatment A1C (p = 0.007). When controlling for BMI, age, and pre-treatment A1C, the >75% adherence group was associated with improved post-treatment A1C (p < 0.001). Discussion:When controlling for all studied variables, testosterone adherence was associated with improved post-treatment A1C. The higher the initial A1C at the initiation of therapy, the higher the potential for lowering the patient's A1C with >75% adherence. Further, all groups showed some reduction in BMI, which may indicate that testosterone therapy may affect A1C independent of weight loss. Conclusion:Even when controlling for improved BMI, pre-treatment A1C, and age, testosterone positively impacted glycemic control in diabetes patients with hypogonadism, with the most benefit noted in those most adherent to therapy (>75%).

Approximately 25% of men with type 2 diabetes mellitus (T2DM) have hypogonadotropic hypogonadism. Although there is a paucity of trials evaluating testosterone therapy in relation to T2DM, there have been recent studies highlighting possible additional benefits of its use in men with T2DM. Our study aims to evaluate the effects of long-term testosterone therapy on A1c in men with co-occurring T2DM. We identified 12,125 military beneficiaries with dual diagnoses of T2DM and hypogonadism from 2005-2018. Roughly 10.5% (1,125) met inclusion criteria: testosterone treatment ≥5 years and available pre-treatment and post-treatment clinical values (A1c, serum testosterone, and BMI). Patients were categorized as follows based on testosterone adherence rates: Group 1 (≥75%; n=72), Group 2 (50-74%; n=172), Group 3 (25-49%, n=266), Group 4 (&lt;25%; n=762). All groups showed improvement in BMI over time, although it was more substantial in Group 1. Pre- and post-treatment BMI values were 33.7 kg/m2 vs. 32.8 kg/m2 for Group 1 (-0.93 kg/m2), 33.7 kg/m2 vs. 33.5 kg/m2 for Group 2 (-0.2 kg/m2), 34.1 kg/m2 vs. 33.8 kg/m2 for Group 3 (-0.3 kg/m2), 33.8 kg/m2 vs. 33.4 kg/m2 for Group 4 (-0.4 kg/m2). Pre- and post-treatment A1c values were 6.8% vs. 6.6% for Group 1 (-0.18%), 7% vs. 7.1% for Group 2 (+0.11%), 7% vs. 7.3% in Group 3 (+0.3%), and 7.4% vs. 7.6% in Group 4 (+0.25%). Thus, the A1c improvement in Group 1 was statistically significant when compared to Group 3 (p=0.045) and Group 4 (p=0.047). Despite improvement in BMI for all groups, only Group 1 showed improvement in A1c. This speaks to the potential effect of testosterone on A1c specifically, irrespective of BMI, as evidenced by the glycemic benefit only seen in those with the highest adherence rates. Disclosure C. Jenkins: None. J.M. Tate: None. J.L. Wardian: None. A. Rittel: None. I. Folaron: None.

United States (U.S.) military service members with diabetes (DM) are restricted from working in austere locations due to concerns over potential glycemic decompensation. However, the policies guiding these duty restrictions may be overcautious and are unsubstantiated by systematic analysis. To address this knowledge gap, we conducted a retrospective study characterizing service members with DM who deployed overseas and analyzed changes in their A1c and BMI before and after deployment. In all branches of the U.S. military (Air Force, Army, Marines, Navy), active duty service members with DM completed 11,206 individual deployments lasting ≥90 days between 2004-2017. Of those, 668 (6%) completed a pre- and post-deployment A1c check within 90 days of departure and repatriation. The majority (81.3%) did not have an A1c check before and/or after deployment. For those with A1c values prior to deployment, 64.5% had an A1c &lt; 7%, 20.2% had an A1c between 7-7.9%, 8.4% had an A1c between 8-8.9%, and 6.9% had an A1c ≥ 9%. Most (61.2%) were taking DM medications, of which metformin was the most common (66.2%), followed by sulfonylureas (22.5%). Despite policy restrictions, 6% deployed on insulin. Coincident hypertension (29%) and lipid disorders (33.1%) were common, but ≤ 1% had microvascular complications. BMI was checked pre- and post-deployment on 3083 individual deployments (28%). Mean A1c and BMI did not significantly change pre- and post-deployment (A1c pre- 6.89% vs. post- 6.93%, p = 0.58; BMI pre- 28.9 kg/m2vs. post- 28.7 kg/m2, p = 0.14). U.S. military medical policies restrict deployments for service members with DM due to a perceived risk of decompensation when medical resources are scarce. However, our data demonstrate that A1c and BMI do not significantly change, suggesting that select service members with DM can maintain adequate glycemic control during deployments. The lack of A1c surveillance for the majority of service members with DM surrounding deployment is concerning and should prompt changes in policy. Disclosure I. Folaron: None. M.W. True: None. J.L. Wardian: None. W.H. Kazanis: None. J.M. Tate: None. T.J. Sauerwein: Speaker's Bureau; Self; AstraZeneca, Merck & Co., Inc. S. Graybill: None. P.G. Clerc: None. C. Jenkins: None.

Introduction Service members (SMs) in the United States (U.S.) Armed Forces have diabetes mellitus at a rate of 2–3%. Despite having a chronic medical condition, they have deployed to environments with limited medical support. Given the scarcity of data describing how they fare in these settings, we conducted a retrospective study analyzing the changes in glycated hemoglobin (HbA1c) and body mass index (BMI) before and after deployment. Materials and Methods SMs from the U.S. Army, Air Force, Navy, and Marine Corps with diabetes who deployed overseas were identified through the Military Health System (MHS) Management Analysis and Reporting Tool and the Defense Manpower Data Center. Laboratory and pharmaceutical data were obtained from the MHS Composite Health Care System and the Pharmacy Data Transaction Service, respectively. Paired t-tests were conducted to calculate changes in HbA1c and BMI before and after deployment. Results SMs with diabetes completed 11,325 deployments of greater than 90 days from 2005 to 2017. Of these, 474 (4.2%) SMs had both HbA1c and BMI measurements within 90 days prior to departure and within 90 days of return. Most (84.2%) required diabetes medications: metformin in 67.3%, sulfonylureas in 19.0%, dipeptidyl peptidase-4 inhibitors in 13.9%, and insulin in 5.5%. Most SMs deployed with an HbA1c &lt; 7.0% (67.1%), with a mean predeployment HbA1c of 6.8%. Twenty percent deployed with an HbA1c between 7.0 and 7.9%, 7.2% deployed with an HbA1c between 8.0 and 8.9%, and 5.7% deployed with an HbA1c of 9.0% or higher. In the overall population and within each military service, there was no significant change in HbA1c before and after deployment. However, those with predeployment HbA1c &lt; 7.0% experienced a rise in HbA1c from 6.2 to 6.5% (P &lt; 0.001), whereas those with predeployment HbA1c values ≥7.0% experienced a decline from 8.0 to 7.5% (P &lt; 0.001). Those who deployed between 91 and 135 days had a decline in HbA1c from 7.1 to 6.7% (P = 0.010), but no significant changes were demonstrated in those with longer deployment durations. BMI declined from 29.6 to 29.3 kg/m2 (P &lt; 0.001), with other significant changes seen among those in the Army, Navy, and deployment durations up to 315 days. Conclusions Most SMs had an HbA1c &lt; 7.0%, suggesting that military providers appropriately selected well-managed SMs for deployment. HbA1c did not seem to deteriorate during deployment, but they also did not improve despite a reduction in BMI. Concerning trends included the deployment of some SMs with much higher HbA1c, utilization of medications with adverse safety profiles, and the lack of HbA1c and BMI evaluation proximal to deployment departures and returns. However, for SMs meeting adequate glycemic targets, we demonstrated that HbA1c remained stable, supporting the notion that some SMs may safely deploy with diabetes. Improvement in BMI may compensate for factors promoting hyperglycemia in a deployed setting, such as changes in diet and medication availability. Future research should analyze in a prospective fashion, where a more complete array of diabetes and readiness-related measures to comprehensively evaluate the safety of deploying SMs with diabetes.