Correlation Between Impaired Sensitivity To Thyroid Hormones And Complications Of Type 2 Diabetes Mellitus

Background:The complications of diabetes have become important causes of death and disability in diabetic patients along with the raised incidence of diabetes.Diabetic kidney disease is one of the main diabetic complications.Sometimes,the clinical symptoms of patients are not obvious,for example,microalbuminuria can be the unique clinical manifestation,leading to delayed diagnosis and treatment.Therefore,it is important to find some markers for predicting the prognosis of diabetic complications,especially for diabetic renal function impairment.Objective:We calculated the indices of impaired sensitivity to thyroid hormones:Thyrotroph thyroxine resistance index(TT4RI),Thyroid-stimulating hormone index(TSHI),Thyroid feedback quantile-based index(TFQI)and Free triiodothyronine to Free thyroxine ratio(FT3/FT4)in order to explore the correlation between impaired sensitivity to thyroid hormones and diabetic complications,and looking forward to providing referenceable value for the prevention,screening of type 2 diabetes complications.Method:We collected 498 diabetes mellitus patients’ information,who were hospitalized in the Department of Endocrinology and Metabolism of our hospital from July 2018 to September 2020.Data missing and thyroid abnormalities were excluded.Finally,310 patients suffering from type 2 diabetes with normal thyroid function were included as our research objects.Then we collected patients’ basic information(name,age,sex,residence,height,weight,duration of diabetes,hypertension history,smoking history,family history of cardiovascular disease,diabetes complications diagnosis),laboratory indexes of patients recorded include serum creatinine,glomerular filtration rate,urine protein,urinary albumin creatinine ratio,uric acid,cystatin C,glycosylated hemoglobin,homocysteine,blood lipid(triglyceride,total cholesterol,high-density lipoprotein cholesterol,low density lipoprotein cholesterol),thyroid hormone(Free triiodothyronine(FT3)and free thyroxine(FT4),thyroid stimulating hormone(TSH)).According to the thyroid hormone level,we calculated the index of impaired sensitivity to thyroid hormones in order of size-small to large,and low value of 75%population was set to the low-risk group(control group)in TT4RI,TSHI,TFQI,high value of 25%was defined as the high-risk group(observation group);high value of 75%in FT3/FT4 was defined as the low-risk group(control group),low value of 25%population was set to the high-risk group(observation group).Our data were analyzed by SPSS25.0 statistical software.We applied statistical methods to process data,such as one-way analysis of variance,t-test,chi-square test and logistic regression analysis.Results:1.There were 310 patients with type 2 diabetes with normal thyroid function who meet the inclusion criteria and exclusion criteria,including 195 males and 115 females.the range of age is 22 up to 85 years old,the average age is 56 years old.2.The incidence of peripheral vascular disease is higher at the high-risk group of TT4RI;The incidence of proteinuria and renal dysfunction is higher at the high-risk group of FT3/FT4.The incidence of increased creatinine is higher at the high-risk group of TFQI and FT3/FT4;The incidence of reduced glomerular filtration rate is higher at the high-risk group of FT3/FT4;The incidence of poor command of glycosylated hemoglobin is higher at the high-risk group of FT3/FT4.3.Logistic regression analysis indicated that,in patients with type 2 diabetes,TSHI high value may be a risk factor for reduced glomerular filtration rate(OR=4.873,P=0.015);TFQI high value may be the risk factor for carotid artery plaque formation(OR=1.995,P=0.047)and reduced glomerular filtration rate(OR=1.280,P=0.004);FT3/FT4 low value may be the risk factor for raising creatinine level(OR=0.243,P=0.029,),reduced glomerular filtration rate(P=0.004,OR=0.654),albuminuria(OR=0.510,P=0.004)and poor control of glycosylated hemoglobin(OR=0.215,P=0.017).Conclusion:1.The impaired sensitivity to thyroid hormones is related to renal function impairment,carotid artery plaque and control of blood glucose in type 2 diabetes mellitus;2.The indices of impaired sensitivity to thyroid hormones:TSHI,TFQI and FT3/FT4,may have a predictive effect in renal function impairment of type 2 diabetes mellitus.