| Background and ObjectiveDiabetes mellitus(DM)is a group of common metabolic and endocrine diseases characterized by disorders of glucose and fat metabolism and increased plasma glucose level,among which type 2 diabetes mellitus(T2DM)is the most common.DM can lead to multiple organ and tissue damage and lead to a variety of chronic complications.Previous studies have shown that the prevalence of hypothyroidism in diabetic patients is higher than that in normal people,but the specific prevalence has been reported differently.Both thyroid disease and diabetes affect the metabolic activities of the body,and kidney injury,especially renal failure,also affects the metabolic activities of the body and insulin degradation.At present,the correlation between diabetes,hypothyroidism and kidney injury has drawn mixed conclusions.Based on this,we discussed the epidemiological characteristics of hypothyroidism in patients with type 2 diabetes and its correlation with e GFR,UACR,blood C-peptide and other factors based on clinical data,in order to provide a reference for thyroid function monitoring in patients with type 2 diabetes,and provide a more accurate basis and possible direction for further research on hypothyroidism in patients with type 2 diabetes.Material and methodThe subjects of this study were type 2 diabetes patients admitted to our hospital from January 2021 to October 2022.Relevant clinical data were collected.Inclusion criteria:(1)Diagnosis of type 2 diabetes with or without diabetic nephropathy;(2)over 18 years old;(3)non-pregnancy.Exclusion criteria:(1)Previous or current hospitalization with hyperthyroidism;(2)various types of acute kidney injury;(3)other types of diabetes;(4)other types of chronic kidney disease;(5)patients undergoing renal replacement therapy;(6)malignant tumor of urinary system;(7)sepsis,severe infection,shock patients.1.Clinical dataDemographic data and medical history: age,sex,body mass index,diabetes duration,hypertension,coronary heart disease,diabetes complications,etc.,of type 2diabetes patients.Clinical relevant routine and biochemical test indicators: thyroid function,biochemistry,liver function,urine routine,etc.2.Grouping and statistical analysis methods2.1 According to inclusion and exclusion criteria,all eligible cases were included in the total sample;Describe the basic demographic and clinical characteristics of patients in the total sample;2.2 Patients with diabetes mellitus were divided into two groups according to whether they had kidney injury or not.Thyroid hormone levels between the two groups were compared and the differences in indexes between the two groups were analyzed.2.3 CKD-GFR stages were grouped according to the 2002 guidelines for Quality of Life in Kidney Disease(K/DOQI).Thyroid hormone levels in different groups were compared,and the correlation between thyroid hormone and different CKD stages was analyzed.2.4 Urinary albumin was grouped according to UACR,thyroid-related hormone levels were compared among patients in different groups,and the correlation between thyroid hormone and different UACR stages was analyzed.2.5 Groups were divided according to fasting C-peptide levels,thyroid related hormone levels were compared in different groups,and the correlation between thyroid hormone and different fasting C-peptide groups was analyzed.2.6 Regression analysis was conducted between FT3 and e GFR,UACR,fasting C-peptide and other indicators.2.7 Stratification was conducted according to sex,age,glycosylation level and BMI level.The relationship between FT3 and e GFR,UACR and fasting C peptide after stratification was compared.2.8 Statistical analysis was performed using SPSS26.0 software.3.Study results3.1 Demographic and clinical data of the enrolled cases3.1.1 According to inclusion and exclusion criteria,751 patients with type 2diabetes were finally included as the total study sample.3.1.2 In the total sample cohort,there were 418 patients over 65 years old,accounting for 55.7%,and the ratio of male to female was 384 cases(51.1%)/367cases(48.9%).There were 109 cases of hypothyroidism(14.5%),including 2 cases of clinical hypothyroidism(0.3%),9 cases of subclinical hypothyroidism(1.2%),90 cases of low T3 syndrome(12%),6 cases of low T4 syndrome(0.8%),and 2 cases of low T3-low T4 syndrome(0.3%).The prevalence of hypothyroidism was higher in age ≥65 years than in age <65 years(36 cases(10.8%)vs 73 cases(17.5%).There was no difference in the prevalence of hypothyroidism between men and women(54cases(14.1%)vs 55 cases(15%)).3.1.3 Comparison of the prevalence of hypothyroidism: BMI<24kg/m^2 vs.BMI≥24kg/m^2(72 cases(18.5%)vs.37 cases(10.2%)),The clinical types was mainly low T3 syndrome,the difference was statistically significant(P<0.05).There was no statistical significance in the prevalence of hypothyroidism between fasting C-peptide <390pmol/l and fasting C-peptide ≥ 390pmol/l,HBA1 c ≤ 7% and Hba1 c >7%.3.2 Comparison of hypothyroidism in diabetic group with renal injury compared with diabetic group without renal injury3.2.1 Hypothyroidism was more common in diabetic patients with kidney injury than in patients without kidney injury(21% vs 11.5%,P=0.001),mainly low T3 syndrome,accounting for 18.9%.3.2.2 The FT3 level in diabetic group with kidney injury was lower than that in diabetic group without kidney injury(3.46(3.86,3.11)vs 3.24(3.65,2.75),P<0.001).There was no significant difference between FT4 and TSH,and both P values were >0.05.3.3 Correlation analysis of thyroid hormone with estimated glomerular filtration rate,urinary albumin creatinine ratio,blood C-peptide and other factors3.3.1 In the total sample cohort,FT3 level was negatively correlated with UACR level(r=-0.234,P<0.001).FT3 was positively correlated with e GFR and fasting C-peptide(r=0.230,P<0.001;r=0.145,P<0.001).3.3.2 FT3 level of patients was negatively correlated with UACR grouping and CKD staging(r=-0.241,P<0.001;r=-0.234,P<0.001),was positively correlated with fasting C-peptide grouping(r=0.154,P<0.001).3.3.3 In the total sample cohort,there was no significant correlation between FT4,TSH and e GFR level and UACR level(all P values >0.05).FT4 was negatively correlated with fasting C-peptide and fasting C-peptide grouping(r=-0.094,P<0.001;r=-0.087,P<0.017),TSH was positively correlated with fasting C-peptide and fasting C-peptide grouping(r=0.169,P<0.001;r=0.164,P<0.001).3.4 Comparison of thyroid hormones in different estimates of glomerular filtration rate,urinary albumin creatinine ratio and blood C-peptide3.4.1 With the progression of CKD stage and UACR,FT3 levels were low(P<0.001)3.4.2 There was no significant correlation between TSH,FT4 level,CKD stage and UACR group,and both P >0.053.4.3 When fasting C-peptide was high,FT3 level and TSH level of patients were high,while FT4 level was low,both P <0.05.3.5 Regression analysis between free T3 grouping and estimated glomerular filtration rate,urinary albumin creatinine ratio,and blood C-peptide3.5.1 Univariate and multivariate results showed that with the increase of e GFR level,the risk of FT3 decreased was smaller(OR=0.987,P=0.001),and with the progression of CKD stage,the risk of FT3 decreased increased(OR >1,P <0.05).3.5.2 Univariate and multivariate results showed that FT3 grouping was not statistically significant with UACR level,OR=1.However,further grouping of UACR showed that when UACR<30mg/g as control group,patients in 30-300mg/g group and UACR>300mg/g group had increased risk of FT3 reduction.(OR >1,P<0.05).3.5.3 Univariate and multivariate results showed that FT3 grouping was not relevant to statistical results of fasting C-peptide level,OR=1.However,further grouping of fasting C-peptide showed that when fasting C-peptide <390pmol/L was taken as control group,the risk of FT3 reduction was reduced in fasting C-peptide≥390pmol/l group,(OR <1.P <0.05).3.5.4 Univariate and multivariate analyses suggested that increased BMI,increased HBA1 c and increased age ≥65 years were associated with increased risk of FT3 reduction,and the results were statistically significant(OR>1,P<0.05).3.6 Stratified analysis of FT3 and estimated glomerular filtration rate,urinary albumin creatinine ratio,blood C-peptide and other factorsFemale patients aged 65 years or older with type 2 diabetes had a higher risk of FT3 reduction when UACR was elevated.4.ConclusionThe people with type 2 diabetes1.The prevalence of hypothyroidism was higher in patients with kidney injury or older than 65 years.There was no difference in prevalence between men and women.2.Most of the clinical manifestations of hypothyroidism were non-thyroid syndrome,among which low T3 syndrome was the most common3.There are many factors affecting hypothyroidism,among which increased urinary protein excretion,decreased renal function and old age are clear risk factors.Low BMI level and high HBA1 c level may also be risk factors,and low C-peptide level is associated with lower FT3. |
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