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To the Editor: In their systematic review and meta-analysis, Dr Ding and colleagues¹ present compelling evidence and arguments for the importance of sex hormones in the development of diabetes and discuss the many studies documenting a relationship between testosterone and diabetes. They describe the paucity of data relating estradiol to diabetes. Estradiol, however, may also have an important relationship with diabetes.

In studies controlling for age and body mass index, the ratio of estradiol to testosterone correlated more strongly with glucose and insulin than did testosterone.² In a multiple regression analysis with estradiol, testosterone, age, and visceral adipose tissue as independent variables, the positive association of estradiol with insulin level was stronger than the negative association of testosterone with insulin level. The estradiol-testosterone ratio, when substituted for estradiol and testosterone, showed a stronger association than either hormone.

In men with type 2 diabetes taking no medication, estradiol was increased more . . . [Full Text of this Article]

Gerald B. Phillips, MD
gbp1@columbia.edu
Department of Medicine
Columbia University College of Physicians and Surgeons
St Luke’s-Roosevelt Hospital Center
New York, NY

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