In fact, when glucose is not available, glycogen is a mobilizable fuel storage that can be readily metabolized. Thus, glycogen should deserve special attention in the future to comprehend its real relevance on these processes, particularly under pathological conditions.Spermatogenesis and sperm maturation are also affected by pH establishment in the several luminal fluids.In fact, disturbances of acidbase homeostasis in the reproductive tract have been associated with male infertilitysubfertility in mammals. Moreover, it is also known that prediabetes cause an alteration in bicarbonate homeodynamics in the lumen of the epididymis. In fact, these two events appear to be interconnected for various reasons.One of the possible explanations is an increased frequency of diabetic men on reproductive age. As discussed in the previous subchapters, the metabolism of testicular cells is pivotal for spermatogenesis.Moreover, glucose and insulin are key players in the control of testicular cells metabolic cooperation.Thus, the deregulation promoted by DM in glucose and insulin might be a key factor to the decline in fertility rate observed in countries with high incidence of metabolic diseases, particularly DM and prediabetes.Testicular function is primarily controlled by pituitary hormones: FSH and LH.Thus, both prediabetes and DM may affect male reproductive function due to their effects on the endocrine control of spermatogenesis. Several of the effects promoted by DM in testicular function have been attributed to the lack of insulin. Moreover, diabetic patients present an abnormal feedback of the hypothalamus pituitary axis by gonadal steroids, either due to inefficient steroid transport into effector cells or reduced pituitary sensitivity. These modifications have a direct effect on germ cell development, namely during spermatogenesis, spermiogenesis and on sperm metabolism leading to abnormalities such as abnormal ultrastructure of ejaculated sperm. DM can cause other sexual disorders including erectile dysfunction, impotence. Some studies have reported anomalous sperm parameters and quality markers in diabetic men.However, the literature shows several contradictory results. While the majority of the studies report one or more anomalies in sperm parameters of diabetic men, such as lower sperm counts, significant differences in sperm motility and morphology, others did not find any significant differences. However, it is less controversial that diabetic patients present higher levels of glucose and fructose in sperm. This fact, along with sperm ineffective metabolic control, led to the establishment that impairment of sperm parameters in diabetic men may be related with hexose metabolism in these cells. Moreover, it was found that DM is associated with increased sperm nuclear and mitochondrial, probably due to oxidative damage, which may impair male fertility and reproductive health.Interestingly, a study has shown that the ejaculate of diabetic men contains higher concentrations of <a href="http://www.targetmol.com/compound/Vitamin-B12">Targetmol's
Cyanocobalamin</a> spermatozoa with disrupted mitochondrial transmembrane potential, activated caspase, reactive oxygen species and fragmented DNA when compared with nondiabetic donors. Moreover, these results were more pronounced in men with TDM. Despite some contradictory studies, it seems clear that diabetic patients have fertility problems.The treatment of diabetic individuals involves high costs and the amount of money spent every year in their treatment is increasing.There are several antidiabetic drugs in the market that can be used either in monotherapy or in combination.