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Spilack ADM, Goulart AC, Janovsky CCPS, de Almeida-Pittito B, Lotufo PA, Sommer Bittencourt M, Generoso G, de Souza Santos I, Bensenor IM. The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 68:e220375. [PMID: 37988662 PMCID: PMC10916802 DOI: 10.20945/2359-4292-2022-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/23/2023] [Indexed: 11/23/2023]
Abstract
Objective We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.
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Affiliation(s)
- Aída de Melo Spilack
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carolina C P S Janovsky
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Bianca de Almeida-Pittito
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo A Lotufo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Giuliano Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Itamar de Souza Santos
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Isabela M Bensenor
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
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Spilack ADM, Goulart AC, de Almeida-Pititto B, Janovsky CCPS, Lotufo PA, Santos IDS, Benseñor IM. The association of diabetes, subclinical hypothyroidism and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil). Clinics (Sao Paulo) 2023; 78:100154. [PMID: 36669424 PMCID: PMC9868869 DOI: 10.1016/j.clinsp.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval ‒ 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT > P75%. RESULTS After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (β = 0.019; 95% CI 0.012 to 0.027; p < 0.0001) and subclinical hypothyroidism more diabetes (β = 0.03; 95% CI 0.010‒0.047, p < 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR = 1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p = 0.29) or as a categorical variable (p = 0.92). DISCUSSION Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected.
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Affiliation(s)
- Aída de Melo Spilack
- Post-Graduate Student, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bianca de Almeida-Pititto
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, São Paulo, SP, Brasil
| | | | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Itamar de Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabela M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, RS, Brasil.
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Chubb SAP, Peters KE, Bruce DG, Davis WA, Davis TME. The relationship between thyroid dysfunction, cardiovascular morbidity and mortality in type 2 diabetes: The Fremantle Diabetes Study Phase II. Acta Diabetol 2022; 59:1615-1624. [PMID: 36083409 PMCID: PMC9581822 DOI: 10.1007/s00592-022-01969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
AIMS It is uncertain whether subclinical thyroid dysfunction is associated with cardiovascular disease (CVD) events and mortality in people with type 2 diabetes. The aim of this study was to determine whether undetected thyroid disease increases the risk of incident CVD and death in type 2 diabetes. METHODS One thousand two hundred fifty participants with type 2 diabetes (mean age 65.3 years, 56.5% males, median diabetes duration 8.0 years) without known thyroid disease and not taking medications known to affect thyroid function were categorised, based on baseline serum free thyroxine (FT4) and thyrotropin (TSH) concentrations, as euthyroid, overt hypothyroid (increased TSH, low FT4), subclinical hypothyroid (increased TSH, normal FT4), overt thyrotoxic (decreased TSH, raised FT4) or subclinical thyrotoxic (decreased TSH, normal FT4). Incident myocardial infarction, incident stroke, all-cause and cardiovascular mortality were ascertained during a mean 6.2-6.7 years of follow-up. RESULTS Most participants with newly-detected thyroid dysfunction had subclinical hypothyroidism (77.2%) while overt/subclinical thyrotoxicosis was infrequent. Compared to participants with TSH 0.34-2.9 mU/L, those with TSH > 5.1 mU/L were not at increased risk of incident myocardial infarction (adjusted hazard ratio (95% confidence limits) 1.77 (0.71, 2.87)), incident stroke (1.66 (0.58, 4.78)), all-cause mortality (0.78 (0.44, 1.37)) or cardiovascular mortality (1.16 (0.38, 3.58)). Independent baseline associates of subclinical hypothyroidism included estimated glomerular filtration rate and systolic blood pressure. CONCLUSIONS Subclinical hypothyroidism was not independently associated with CVD events or mortality in community-dwelling people with type 2 diabetes despite its associations with CVD risk factors, questioning strategies to identify and/or treat mild thyroid dysfunction outside usual care.
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Affiliation(s)
- S A Paul Chubb
- Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
- PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Kirsten E Peters
- Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
| | - David G Bruce
- Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
| | - Wendy A Davis
- Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
| | - Timothy M E Davis
- Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia.
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Wu Y, Wan Q, Xu Y, Li J, Li K, Zhang Z, Tang Q, Miao Y, Yan P. Lower Visceral Fat Area in Patients with Type 2 Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2022; 15:3639-3654. [PMID: 36439295 PMCID: PMC9694982 DOI: 10.2147/dmso.s388330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE There is preliminary evidence that visceral fat area (VFA) was associated with the presence of type 2 diabetic peripheral neuropathy (DPN) in the Korean population; however, no studies have reported the association in Chinese population. The purpose of this study was to explore the possible correlation of VFA with DPN in such a population. METHODS A total of 2498 hospitalized patients with type 2 diabetes mellitus (T2DM) undergone VFA measurement, and were divided into DPN group (n=900) and non-DPN group (n=1594). The association of VFA with the presence of DPN was evaluated by correlation and multiple logistic regression analyses, generalized additive model with a smooth curve fitting, and receiver operating characteristic (ROC) curve analysis. RESULTS The VFA was significantly lower in the DPN group than in the non-DPN group (P < 0.001). VFA was significantly and positively associated with sural nerve conduction velocity (SNCV) and amplitude potential (SNAP) and negatively associated with the presence of DPN (all P< 0.001); there was no significant difference in the curve fitting (P = 0.344). Multivariate logistic regression analysis showed that the risk of presence of DPN decreased progressively across the VFA quartiles (P for trend < 0.001) and was significantly lower in patients in the highest VFA quartile than in those in the lowest quartile (OR: 0.382, 95% CI 0.151-0.968, P< 0.001) after multivariate adjustment. The ROC analysis revealed that the best cut-off value of VFA for predicting the presence of DPN was 50.5cm2 (sensitivity 84.40%; specificity 34.00%). CONCLUSION These results suggest that lower VFA level may be associated with increased risk of the presence of DPN in T2DM patients.
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Affiliation(s)
- Yuru Wu
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Qin Wan
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Yong Xu
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Jia Li
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Ke Li
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Zhihong Zhang
- Department of General Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Qian Tang
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Ying Miao
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
| | - Pijun Yan
- Department of Endocrinology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, Sichuan, People’s Republic of China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, People’s Republic of China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, People’s Republic of China
- Correspondence: Pijun Yan, Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China, Tel/Fax +86-830-3165361, Email
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Li MF, Ke JF, Li S, Wang JW, Zhu ZH, Li JB. Serum free triiodothyronine is inversely associated with diabetic peripheral neuropathy but not with carotid atherosclerotic lesions in euthyroid patients with type 2 diabetes. Diabetol Metab Syndr 2021; 13:142. [PMID: 34863289 PMCID: PMC8645151 DOI: 10.1186/s13098-021-00760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The associations between serum free triiodothyronine (FT3) and diabetic peripheral neuropatprohy (DPN)/carotid atherosclerotic lesions in euthyroid patients with type 2 diabetes are still unclear. The purpose of our study was to explore the relations of FT3 to DPN and carotid atherosclerotic lesions in Chinese type 2 diabetes inpatients with euthyroid function. METHODS 2477 euthyroid inpatients with type 2 diabetes were recruited and they were stratified into quartiles by FT3 levels in this cross-sectional study. Peripheral neuropathy was assessed by neurological symptoms and signs as well as nerve conduction velocity tests. Carotid atherosclerotic lesions, including carotid intima-media thickness, plaque and stenosis, were evaluated by Doppler ultrasound. RESULTS The prevalence of DPN in type 2 diabetic patients exhibited the significant decrease across the FT3 quartiles (23.5%, 20.9%, 18.8%, and 11.2%, respectively, p < 0.001). Multiple logistical regression analysis also revealed that FT3 quartiles were significantly and inversely associated with DPN. Compared with the subjects in the highest FT3 quartile, the adjusted odds ratios (95% confidence interval) of DPN from the first to third FT3 quartile were successively 2.338 (1.407-3.884), 1.903 (1.134-3.194) and 1.598 (0.960-1.125). The patients with DPN had significantly higher prevalence of carotid atherosclerotic lesions compared with non-DPN patients. However, no statistical association was observed between FT3 quartiles and carotid atherosclerotic lesions after adjusting for confounder factors. CONCLUSIONS Lower FT3 within the normal range was independently associated with DPN, but not with carotid atherosclerotic lesions in Chinese euthyroid inpatients with type 2 diabetes.
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Affiliation(s)
- Mei-Fang Li
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiang-Feng Ke
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Shuai Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jun-Wei Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Zhi-Hui Zhu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Jing-Bo Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Tapper M, McGrowder DA, Dilworth L, Soyibo A. Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients. Diseases 2021; 9:diseases9010005. [PMID: 33401560 PMCID: PMC7838907 DOI: 10.3390/diseases9010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. METHODS A cross-sectional study was conducted involving 140 CKD patients (stages 1-5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. RESULTS 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1-5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2-5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. CONCLUSIONS 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.
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Affiliation(s)
- Marlene Tapper
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
| | - Donovan A. McGrowder
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
- Correspondence:
| | - Lowell Dilworth
- Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica; (M.T.); (L.D.)
| | - Adedamola Soyibo
- Department of Medicine, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica;
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Yan P, Zhang Z, Miao Y, Xu Y, Zhu J, Wan Q. Physiological serum total bilirubin concentrations were inversely associated with diabetic peripheral neuropathy in Chinese patients with type 2 diabetes: a cross-sectional study. Diabetol Metab Syndr 2019; 11:100. [PMID: 31827625 PMCID: PMC6889527 DOI: 10.1186/s13098-019-0498-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although bilirubin has been generally regarded as a waste with potential neurotoxicity at high levels, a few clinical studies suggest a potential protective role of physiological serum total bilirubin (TBIL) concentrations in diabetic peripheral neuropathy (DPN). However, the pathological mechanisms underlying the relationship remain poorly understood. The objective of this study was to explore the relationship between serum TBIL and DPN, and clinical and laboratory parameters. METHODS Serum TBIL was measured in 1342 patients with type 2 diabetes mellitus (T2DM). The relationship between TBIL and DPN and other parameters was analyzed. RESULTS Serum TBIL levels were significantly lower in T2DM patients with DPN, and were independently and negatively associated with vibration perception thresholds (VPT) (P < 0.01 or P < 0.05). Moreover, serum TBIL was negatively associated with neutrophil and white blood cell counts, fibrinogen, and the prevalence of hypertension, diabetic foot ulceration, peripheral arterial disease, diabetic nephropathy and diabetic retinopathy (P < 0.01 or P < 0.05). Additionally, serum TBIL was an independent decisive factor for the presence of DPN after multivariate adjustment. Compared to the highest quartile of TBIL, the lower quartiles were associated with a significantly increased risk of DPN (P < 0.01). Last but most importantly, the analysis of receiver operating characteristic curves revealed that the best cutoff value for serum TBIL to predict DPN was 10.75 μmol/L (sensitivity 54.6% and specificity 62.9%). CONCLUSIONS These findings suggest that lower physiological serum TBIL may be associated with the presence of DPN due to its decreased anti-inflammatory and vascular protective effects.
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Affiliation(s)
- Pijun Yan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
| | - Zhihong Zhang
- Department of General Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
| | - Ying Miao
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
| | - Yong Xu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
| | - Jianhua Zhu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
| | - Qin Wan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
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Mendes D, Alves C, Silverio N, Batel Marques F. Prevalence of Undiagnosed Hypothyroidism in Europe: A Systematic Review and Meta-Analysis. Eur Thyroid J 2019; 8:130-143. [PMID: 31259155 PMCID: PMC6587201 DOI: 10.1159/000499751] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 03/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with undiagnosed hypothyroidism are not treated for the disease and are at high risk of developing serious complications, with major impact on public health. There is a need to systematically review the available evidence on this topic. OBJECTIVE To identify the prevalence of undiagnosed hypothyroidism in Europe. METHODS A systematic review of the literature (Medline, EMBASE, and Cochrane Central) was performed to identify epidemiological studies on the prevalence of undiagnosed hypothyroidism among European populations published between January 2008 and April 2018. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Random-effects meta-analyses were performed to pool estimates of proportions (with 95% confidence intervals [CIs]) of undiagnosed (1) subclinical, (2) overt, and (3) total hypothyroidism. RESULTS The search returned 15,565 citations (4,526 duplicates). Twenty papers were included in the study. Fourteen and 6 studies were of good and moderate methodological quality, respectively. The results of the meta-analyses were as follows for the prevalence of undiagnosed hypothyroidism: subclinical, 4.11% (95% CI 3.05-5.31%, I2 = 99.32%); overt, 0.65% (95% CI 0.38-0.99%, I2 = 96.67%); and total, 4.70% (95% CI 2.98-6.79%, I2 = 99.53%). According to the sensitivity analysis, the prevalence of hypothyroidism tends to be higher in female patients, in those aged ≥65 years, among studies with lower sample sizes, in those with thyroid-stimulating hormone levels <4.5 mIU/L, and in Eastern and Southern Europe. CONCLUSIONS The current evidence suggests that a considerable proportion of the European population has hypothyroidism, particularly subclinical hypothyroidism, which is undiagnosed. This issue deserves further investigation because of possible deleterious consequences for public health.
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Affiliation(s)
- Diogo Mendes
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Carlos Alves
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
| | | | - Francisco Batel Marques
- Center for Health Technology Assessment and Drug Research, Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal
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Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev 2019; 40:789-824. [PMID: 30649221 PMCID: PMC6507635 DOI: 10.1210/er.2018-00163] [Citation(s) in RCA: 232] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - R Paul Robertson
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington School of Medicine, Seattle, Washington.,Department of Pharmacology, University of Washington, Seattle, Washington
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10
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Wang J, Li H, Tan M, Gao G, Zhang Y, Ding B, Su X, Kong X, Ma J. Association between thyroid function and diabetic nephropathy in euthyroid subjects with type 2 diabetes mellitus: a cross-sectional study in China. Oncotarget 2019; 10:88-97. [PMID: 30719205 PMCID: PMC6349442 DOI: 10.18632/oncotarget.26265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 02/28/2018] [Indexed: 12/19/2022] Open
Abstract
Previous studies have suggested that even in euthyroid subjects, thyroid function may affect the risk factors of diabetic nephropathy (DN). Thus, we investigated the association between thyroid parameters and DN in euthyroid subjects with type 2 diabetes mellitus (T2DM). This was a cross-sectional study of 1,071 euthyroid subjects with T2DM (mean age of 61.90 ± 12.74 years; 622 men). Clinical factors, including levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroid autoantibodies, albumin excretion rate were measured. DN was present in 400 (37.35%) individuals. Patients with DN exhibited higher serum TSH and lower serum FT3 and FT4 levels than those without DN (P<0.05). After adjusting traditional risk factors of DN, the levels of both FT3 (per-SD increase, odds ratio [OR] 0.606 [95% confidence interval (CI), 0.481-0.762], P<0.001) and FT4 (per-SD increase, OR 0.944 [0.894-0.998], P = 0.040) were inversely correlated with DN. Meanwhile, we found that serum TSH levels were positively correlated with DN (per-SD increase, OR1.179 [1.033-1.346], P = 0.015). Low-to-normal thyroid hormones (THs) were also associated with the presence of macroalbuminuria. In conclusion, the relatively low levels of THs were significantly associated with DN in euthyroid subjects with T2DM.
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Affiliation(s)
- Jian Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Huiqin Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Mingjuan Tan
- Department of Clinical Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Gu Gao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Ying Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Xiaocen Kong
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
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Zhang S, Feng G, Kang F, Guo Y, Ti H, Hao L, Gao P, Gao J. Hypothyroidism and Adverse Endpoints in Diabetic Patients: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2019; 10:889. [PMID: 31998230 PMCID: PMC6965024 DOI: 10.3389/fendo.2019.00889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: This study investigated the relationship strength between hypothyroidism and cardiovascular and renal outcomes in diabetic patients. Methods: The electronic databases PubMed, EmBase, and Cochrane library were screened for relevant studies published before November 2018. The outcomes included major cardiovascular events (MACEs), all-cause mortality, cardiac death, stroke, diabetic nephropathy (DN), diabetic retinopathy (DR), and chronic kidney disease (CKD). The pooled results for all outcomes were calculated using random-effects models. Results: A total of eight studies met the inclusion criteria. The summary results indicated that hypothyroidism was not associated with the risk of MACEs (OR:1.21; 95%CI:0.68-2.16; P = 0.514), all-cause mortality (OR:1.27; 95%CI:0.93-1.74; P = 0.136), cardiac death (OR:1.16; 95%CI:0.89-1.52; P = 0.271), stroke (OR:0.96; 95%CI: 0.49-1.88; P = 0.915), and DN (OR:1.71; 95%CI:0.37-7.90; P = 0.490). There was a significant association between hypothyroidism and the risk of DR (OR:1.73; 95%CI:1.08-2.77; P = 0.023) and CKD (OR:1.22; 95%CI:1.10-1.36; P < 0.001). Conclusions: These findings indicate that diabetic patients with hypothyroidism have an increased risk of DR and CKD. Additional large-scale prospective studies should be carried out to verify the prognosis of patients with diabetes and hypothyroidism.
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Affiliation(s)
- Shaojun Zhang
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
- Department of Endocrinology, The Sixth Division Hospital of Xinjiang Production and Construction Corps, Wujiaqu, China
- *Correspondence: Shaojun Zhang
| | - Guilong Feng
- Department of Emergency, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Fangfang Kang
- The Department of Endocrinology, The Central Hospital of Linfen City, Linfen, China
| | - Yali Guo
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
| | - Hongyan Ti
- The Department of Digestive, Linfen People's Hospital, Linfen, China
| | - Lufang Hao
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
| | - Peng Gao
- Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China
| | - Jiangqin Gao
- Department of Endocrinology, The Sixth Division Hospital of Xinjiang Production and Construction Corps, Wujiaqu, China
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Jaimes MC, Torrado LAA, Reyes NFS, Mackenzie JC, Mallarino JPU. Hypothyroidism is a Risk Factor for Atrial Fibrillation after Coronary Artery Bypass Graft. Braz J Cardiovasc Surg 2017; 32:475-480. [PMID: 29267609 PMCID: PMC5731311 DOI: 10.21470/1678-9741-2017-0080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/08/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Few reports in the world have shown a differential effect of hypothyroidism in relation to morbidity and mortality following cardiac surgery. OBJECTIVE To determine the association between preoperative hypothyroidism, composite and disaggregated outcomes of mortality and complications in patients undergoing first-time isolated myocardial revascularization surgery. METHODS Historical cohort of patients undergoing myocardial revascularization between January 2008 and December 2014, with 626 patients included for evaluation of the composite and disaggregated outcomes of in-hospital mortality and complications (atrial fibrillation, surgical site infection and reoperation due to bleeding). A logistic regression model was used to determine the association between hypothyroidism and the onset of those outcomes. RESULTS Cohort of 1696 eligible patients for the study, with 1.8 mortality. Median age, female gender and prevalence of arterial hypertension were all significantly higher among hypothyroid patients. No differences were found in other preoperative or intraoperative characteristics. Hypothyroidism was associated with the presence of the composite outcome, RR 1.6 (1.04-2.4) and atrial fibrillation 1.9 (1.05-3.8). No association with mortality, infections or reoperation due to bleeding was found. CONCLUSION Hypothyroidism is a disease that affects females predominantly and does not determine the presence of other comorbidities. Hypothyroidism is a risk factor for the onset of postoperative fibrillation in patients undergoing myocardial revascularization surgery. Postoperative care protocols focused on the prevention of these complications in this type of patients must be instituted.
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Mohamed GA, Elsayed AM. Subclinical hypothyroidism ups the risk of vascular complications in type 2 diabetes. ALEXANDRIA JOURNAL OF MEDICINE 2017. [DOI: 10.1016/j.ajme.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ghada A. Mohamed
- Department of Internal Medicine, Assiut Faculty of Medicine, Assiut University, Egypt
| | - Amira M Elsayed
- Department of Internal Medicine, Benha Faculty of Medicine, Benha University, Egypt
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Zhou JB, Li HB, Zhu XR, Song HL, Zhao YY, Yang JK. Subclinical hypothyroidism and the risk of chronic kidney disease in T2D subjects: A case-control and dose-response analysis. Medicine (Baltimore) 2017; 96:e6519. [PMID: 28403083 PMCID: PMC5403080 DOI: 10.1097/md.0000000000006519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Evidence indicated a positive association between subclinical hypothyroidism (SCH) and cardiovascular diseases. But the relationship between SCH and chronic kidney diseases (CKD) remains unclear. A case-control study was performed to ascertain this relationship followed by a meta-analysis. In this hospital-based, case-control study, we recruited 3270 type 2 diabetic patients with euthyroidism and 545 type 2 diabetic patients with SCH. All English studies were searched upon the relationship between SCH and CKD up to October 2016. Meta-analysis was performed using STATA 13.0 software. Our case-control study indicated an association between SCH and CKD in patients with type 2 diabetes [OR (95% CI): 1.22 (1.09-1.36)]. Five observational studies reporting risk of CKD in SCH individuals were enrolled. A significant relationship between SCH and CKD was shown [pooled OR 1.80, (95% CI) 1.38-2.35]. Among normal TSH range, individuals with TSH ≥3.0 μIU/ml had a significantly higher rate of CKD (Fisher exact test, P = 0.027). Dose-response linear increase of CKD events was explored [pooled OR 1.09 (95% CI): 1.03-1.16 per1 mIU/L increase of TSH]. The present evidence suggests that SCH is probably a significant risk factor of CKD in T2D. Linear trend is shown between TSH elevation and CKD in T2D. This relationship between serum TSH and renal impairment in type 2 diabetic patients needs further studies to investigate.
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Affiliation(s)
- Jian-Bo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Hong-Bing Li
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Xiao-Rong Zhu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Hai-Lin Song
- Department of General Surgery, Weihaiwei People's Hospital, Weihai
| | | | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing
- Beijng Key Laboratory of Diabetes Research and Care, Beijing, China
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Song F, Bao C, Deng M, Xu H, Fan M, Paillard-Borg S, Xu W, Qi X. The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus. Endocrine 2017; 55:179-185. [PMID: 27605039 DOI: 10.1007/s12020-016-1095-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/13/2016] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.
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Affiliation(s)
- Fei Song
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Cuiping Bao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Meiyu Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Hui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Meijuan Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
| | - Stéphanie Paillard-Borg
- Department of Medicine and Public Health, The Swedish Red Cross University College, Stockholm, Sweden
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China
- Aging Research Center (ARC), Department Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, PR, China.
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Zhao W, Zeng H, Zhang X, Liu F, Pan J, Zhao J, Zhao J, Li L, Bao Y, Liu F, Jia W. A high thyroid stimulating hormone level is associated with diabetic peripheral neuropathy in type 2 diabetes patients. Diabetes Res Clin Pract 2016; 115:122-9. [PMID: 26822260 DOI: 10.1016/j.diabres.2016.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/13/2015] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
AIM The association between thyroid stimulating hormone (TSH) and type 2 diabetes mellitus (T2DM) is well known. However, whether TSH is related to diabetic peripheral neuropathy (DPN) has not been studied. The aim of this study was to explore the relationship between TSH and DPN in Chinese patients with T2DM. METHODS In this cross-sectional study, 605 patients with T2DM were enrolled. Subclinical hypothyroidism (SCH) was defined as an elevated TSH level (>4.0mIU/L) and a normal free thyroxine level. DPN was evaluated by neurological symptoms, neurological signs, and electromyogram. RESULTS Serum TSH levels were significantly higher in DPN and signs of DPN compared with non-DPN T2DM patients (both P<0.01).The prevalence of DPN and signs of DPN in SCH subjects was higher than that in euthyroid subjects (both P<0.01). Spearman's correlation analysis showed that the serum TSH level was positively associated with DPN (r=0.172, P<0.01). A significant independent association between TSH and DPN was found by multiple logistic regression analysis after adjusting for potential confounding variables [odds ratio (OR)=1.365, P<0.01]. The patients were sequentially assigned to quartiles according to TSH level. Compared with quartile 1, patients in quartile 2 (P<0.01), quartile 3 (P=0.01), and quartile 4 (P<0.01) had a higher risk of DPN. Receiver-operating characteristic curve analysis revealed that the optimal cutoff point of TSH to indicate DPN was 3.045mIU/L in men and 2.94mIU/L in women. CONCLUSION TSH level is independently associated with DPN in Chinese population with T2DM. A high serum TSH level may be a potential risk factor for DPN.
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Affiliation(s)
- Weijing Zhao
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Hui Zeng
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Xiaoyan Zhang
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Fengjing Liu
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Jiemin Pan
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Jungong Zhao
- Department of Interventional Radiology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Zhao
- Department of Vascular Surgery, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lianxi Li
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Fang Liu
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
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Tatar E, Karan C, Kircelli F. The dilemma of subclinical hypothyroidism and renal complications in Type 2 diabetes. Diabet Med 2016; 33:135. [PMID: 26471107 DOI: 10.1111/dme.12990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- E Tatar
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir
| | - C Karan
- Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Izmir
| | - F Kircelli
- Fresenius Medical Care, Istanbul, Turkey
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