The SA Journal Diabetes & Vascular Disease Vol 12 No 1 (July 2015)

REVIEW

SA JOURNAL OF DIABETES & VASCULAR DISEASE

VOLUME 12 NUMBER 1 • JULY 2015

SC metabolism is crucial for successful spermatogenesis. These

cells are known as ‘nurse cells’ since one of their main functions

is to metabolise glucose into lactate, which is then consumed by

the developing germ cells.

Therefore the hormonal control of SC

metabolism has a direct effect on spermatogenesis

and should

deserve special attention when studying metabolic diseases that

are also related with hormonal (de)regulation.

Moreover, diabetic individuals have severe insulin deregulations

that should be taken in consideration when discussing the effects

of DM. Euglycaemia is difficult to maintain in diabetic patients and

hypoglycaemia/hyperinsulinaemia as well as hyperinsulinaemia/

hypoglycaemia are common events that diabetic individuals may

face daily. Therefore, insulin can have a major role in the male

sexual dysfunction associated with DM.

In fact, recent reports show that only a few hours of insulin

deprivation can alter not only glucose metabolism in SCs

but

also completely suppresses

in vitro

acetate production.

The

regulation performed by insulin in these crucial processes for

a normal spermatogenesis is clear evidence that the molecular

mechanisms by which DM affects the male reproductive function

may also be linked to insulin fluctuations and not only to glucose

concentrations.

There is an urgent need for clarification whether DM can

alter sperm parameters and overall male reproductive function.

Furthermore, there is also a lack of consensus concerning sperm

analysis, and it has been recently discussed that conventional sperm

analysis is very limited and needs standardisation before it can give

definite answers to the fertility status of individuals.

Besides, when

assessing the effect of DM, there are several factors that are very

difficult to control, such as the duration of the disease, glycaemic

levels, type of treatment, as well as all the co-morbidities associated,

which may obscure the real impact of DM in male fertility.

It is evident that not all diabetic men are infertile and sperm

analysis is not able to give an absolute answer to the question.

Nonetheless, the molecular mechanisms of spermatogenesis and

sperm maturation might be altered even when conventional sperm

parameters appear normal. Therefore it is imperative to focus not

only on the mechanisms that have a direct effect in natural and

assisted conception, such as DNA integrity and oxidative stress, but

also in the molecular basis of the disease that may affect testicular

cells, spermatogenesis, sperm production and sperm maturation.

These molecular studies may not only open new insights on the

DM effects in male reproductive function, but also point toward

possible therapeutic sites for intervention to decrease DM-related

male subfertility and/or infertility.

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