| ObjectiveThe purpose of this study was to explore the relationship between thyroid stimulating hormone(TSH)and insulin resistance(IR)in elderly type 2 diabetic patients with normal thyroid function,so as to provide more clinical basis for IR,screen thyroid function in early stage of diabetic patients,better reduce blood glucose and control various complications,and improve the quality of life of diabetic patients.Methods318 cases of elderly T2 DM who were hospitalized in the Department of Endocrinology of Ningxia Medical University General Hospital and Cardiovascular and Cerebral Vascular Diseases Hospital from December 2018 to June 2020 were selected,and their ages were 60 years or older.The average age was(67.36±5.82)years old,the average course of disease was(9.81±8.38)years.The subjects were divided into two groups according to gender,150 males and 168 females.Taking Hb A1 c value 7.5% as the cut-off point,The subjects were divided into two groups,namely a low-Hb A1 c group(n = 101)and a high-Hb A1 c group(n = 217),and the TSH in the normal range was divided into three groups by three-point method,namely T1(normal range low TSH group 135 examples: 0.35-2.07 u IU/m L),T2(normal range middle TSH group119 examples:2.07-3.78 u IU/m L),T3(normal range high TSH group 64examples:3.78-5.5u IU/m L).The basic information of gender,age,height,weight,blood pressure and smoking history were collected,and the body mass index(BMI)was calculated.Blood samples were taken in the morning of the next day: blood glucose,blood lipid,C-peptide and thyroid function.Insulin resistance index and islet beta cell function were calculated by homeostasis model.Objective to summarize and analyze the relationship between thyroid stimulating hormone(TSH)and insulin resistance(IR)in elderly patients with type 2 diabetes mellitus.Results1.Analysis of clinical data of patients with type 2 diabetes mellitus: Compared with female patients,DBP and TC in male patients were decreased significantly(P < 0.05).There was no significant differences between age,disease course,smoking,SBP,BMI,FPG,FCP,FT4,FT3,TSH,HOMA-IR,HOMA-β,Hb A1 c,TG and TG/HDL-C in two gender groups(P > 0.05).2.Analysis of low Hb A1 c group and high Hb A1 c group: Compared with low Hb A1 c group,HOMA-IR,BMI,FPG,TC,TG,TG/HDL-C,DBP were significantly increased in high Hb A1 c group(P < 0.05);FCP and HOMA-β in high Hb A1 c group were lower than those in low Hb A1 c group(P < 0.01).However,there was no significant difference in age,smoking,disease duration,SBP,FT3,FT4,TSH,LDL-C,HDL-C between the two groups(P > 0.05).3.All the type 2 diabetes mellitus were divided into three groups(T1、T2、T3)according to TSH three score method.HOMA-IR,FPG,FCP and BMI in T3 and T2 groups were significantly higher than those in T1 group.In T3 group,it was found that HOMA-IR was significantly higher than that in T1 and T2 groups(P < 0.05).And there were no significant differences in SBP,DBP,HDL-C,Hb A1 c,HOMA-β,HDL-C,age among the other three groups.4.Correlation analysis between TSH and HOMA-IR :Pearson analysis showed that there was a positive linear correlation between serum TSH and HOMA-IR in type 2 diabetes patients with high and low Hb A1 c levels(r = 0.330 and 0.251 P < 0.05).BMI was also linearly positively correlated with HOMA-IR(r = 0.210 and 0.334,respectively,both P <0.05).After adjusting for age with Stepwise linear regression analysis,it was found that TSH and BMI were independent risk factors of HOMA-IR.5.All the subjects were divided into 3 groups by the boundary of 24kg/m~2 and 28kg/m~2,and the correlation between TSH and HOMA-IR under different BMI conditions was analyzed.In the 3 groups,TSH level and HOMA-IR were linearly positively correlated(r =0.175,0.277,0.288,P < 0.05),and BMI > 28kg/m~2,that is,in obese T2 DM patients,TSH and HOMA-IR were more strongly correlated.Conclusion1.TSH and BMI are independent risk factors for insulin resistance,and with the increase of TSH and BMI,insulin resistance becomes more serious.Therefore,in elderly patients with type 2 diabetes,dynamic detection of TSH level,understanding of thyroid function,and appropriate intervention if necessary,will help to improve the degree of insulin resistance.2.Insulin resistance is more significant in obese patients with type 2 diabetes. |
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