The Association Between Hypothyroidism And Vascular Complications In Patients With Type 2 Diabetes Mellitus

Objective:To analyse the effects of different severity of hypothyroidism on relevant metabolic indicators in patients with T2DM and to explore the effects of different severity of hypothyroidism on vascular complications in patients with T2DM.Research objects and methods:According to inclusion criteria,203 patients with T2DM who were hospitalized in 2^ndaffiliated hospital of Nanchang university from January,2018 to December,2021 was retrospectively analyzed.These patients were divided into 4 groups:53 in group A（normal thyroid function）,59 in group B（mild SCH）,33 in group C（severe SCH）and 58 in group D（clinical hypothyroidism）,respectively.The general information including gender,age,BMI,duration of hypertension,systolic blood pressure diastolic blood pressure,duration of DM,history of smoking,history of alcohol consumption were recorded..Laboratory tests including TSH,FT3,FT4,FPG,Hb A1c,TC,TG,HDL-C,LDL-C,serum glutamat transaminase,ALBU,e GFR,SCr were collected..The complications and comorbidities of DN,PAD,,CHD and stroke were recorded.Differences in general information,laboratory tests and the prevalence of complications and comorbidities in these groups were compared.The risk factors of DN,PAD,CHD and stroke were respectively analyzed by multi-factor logistic regression.Results:1.The proportion of female patients was higher in group B than in group A（72.9%vs.45.3%,P<0.05）,while the differences in gender between the remaining groups were not statistically significant.（7.5）vs 10.0（6.5）years;D vs A:6.0（9.0）vs10.0（6.5）years.p<0.05].No differences in the duration of DM were discovered among groups B,C and D,and no differences in age,history of smoking,history of alcohol consumption,duration of hypertension,systolic blood pressure,diastolic blood pressure and BMI were found among the four groups.2.LDL-C levels in groups B,C and D were higher than those in group A（P<0.05）;HDL-C levels in group A were higher than those in groups C and D（P<0.05）;TC levels in group B were higher than those in group A（P<0.05）;TG in groups B,C and D were higher than those in group A（P<0.05）;SCr in group D was higher than those in groups A and B（P<0.05）;e GFR in group D was lower than that in groups A and B（P<0.05）;ALBU in group D was higher than that in groups A and B（P<0.05）;the levels of LDL-C,HDL-C,TC,TG,SCr,e GFR and ALBU were not statistically significantly different among the remaining groups,and the levels of FPG,Hb A1c and GPT were not statistically different among the four groups.3.TSH levels was higher in groups B,C and D than in group A（P<0.05）,and higher in both groups C and D than in group B（P<0.05）,but no differenceof TSH was displayed between groups C and D.FT3 levels was higher in groups A,B and C than in group D（P<0.05）,but no difference of FT3 among group A,B and C.Patients in group A had higher FT4 levels than those in group B,C and D（P<0.05）,and patients in group B had higher FT4 levels than those in group C and D（P<0.05）,and patients in group C had higher FT4 levels than those in group D（P<0.05）.4.The prevalence of DN was lower in group A than in Group D（p<0.05）,and lower in group B than in groups C and D（p<0.05）,but no significant difference was discovered in the remaining groups.The prevalence of CHD was higher in group D than in group A,B and C,respectively（p<0.05）,but no difference in the remaining groups No differences in the prevalence of PAD and stroke were found among the four groups.5.Univariate analysis of the T2DM complications.DN:Higher age,systolic blood pressure,SCr,ALBU,and longer duration of DM and duration of hypertension,and lower FT3 and e GFR levels were displayed in patients with DN,compared to those without DN,while no significant differences were found in the remaining indicators.PAD:Patients with PAD had higher age,longer duration of DM and lower diastolic blood pressure than those without PAD（P<0.05）,while no differences were found in the other indicators.CHD:Patients with CHD had higher age,FPG and TG,lower FT3,FT4 and e GFR,and longer duration of hypertension than those without CHD（P<0.05）.Stroke:The prevalence of stroke was higher in men than in women.Longer duration of DM,higher systolic blood pressure and lower FT4 levles were discovered in patients with stroke than in those without stroke（P<0.05）.No difference was observed for the remaining indicators.6.By multi-factor logistic regression analysis,for each complication,both hypertension duration and FT3 reduction were independent risk factors for the occurrence of DN（OR=1.083,6.602 respectively,P<0.05）,and age was an independent risk factor for the occurrence of PAD[OR=1.130（95%CI:1.078～1.184）,P<0.001].All the age,elevated TG and reduced FT3 were all independent risk factors for the development of CHD（OR=1.141,1.295,7.039,respectively,P<0.05）.Men and elevated systolic blood pressure were independent risk factors for the development of stroke（OR=2.606,1.030,respectively,P<0.05）.Conclusion:In T2DM patients,clinical hypothyroidism is associated with the development of DN and CHD,and reduced FT3 is a significant risk factor of DN and CHD.