| Objective:The aim of this study is to evaluate the relationship between thyroid stimulating hormone level and insulin resistance in patients with type 2 diabetes and non-diabetic patients who are with normal thyroid function.It was supposed to provide more Chinese people,s evidence for the study of the mechanism of IR to guide the treatment of patients to reduce insulin resistance and reduce the incidence of cardiovascular events.Methods:From January 1,2015 to June 30,2016,a total of 511 outpatients in Xuyi people's hospital were enrolled in this study: 338 with type 2 diabetes mellitus and 173 nondiabetic individuals.Based on a cut off Hb A1 c value of 7%,type 2 diabetic patients were additionally divided into 2 groups: a high-Hb A1 c group(n=270)and a low-Hb A1 c group(n=68).Clinical data included age,sex,weight,height,concomitance hypertension,coronary heart disease(CHD)and stroke,smoking status,and drugs.Blood glucose,blood lipid,serum insulin and thyroid function were detected,and insulin resistance index(HOMA-IR)and body mass index(BMI)were calculated.The differences of demography,blood glucose,blood lipid,serum insulin and thyroid function among different groups were compared,and the correlation between TSH level and HOMA-IR was analyzed.Results:1.There was no statistical difference in age,sex,prevalence of stroke,smoking history,the use of aspirin and statin between the three groups.2.There were no statistical differences in duration of diabetes,the usage rate of insulin secretagogues and metformin between high Hb A1 c group and low Hb A1 c group.3.Compared with the non diabetic group,the incidence of hypertension and coronary heart disease in the high Hb A1 c group and the low Hb A1 c group increased significantly(P<0.05),but there was no statistical difference between the high Hb A1 c group and the low Hb A1 c group in the incidence of hypertension and coronary heart disease(P>0.05).4.The serum cholesterol levels in the high Hb A1 c group and the low Hb A1 c group were significantly higher than those in the non diabetic group,and the serum cholesterol level in the high Hb A1 c group was higher than that in the low Hb A1 c group(P<0.05).5.The level of serum triglyceride in the high Hb A1 c group was higher than that in the low Hb A1 c group and the non diabetic group(P<0.05),but the triglyceride level in the low Hb A1 c group was not significantly different from that in the non diabetic group(P>0.05).6.The blood low density lipoprotein(LDL-C)level in the high Hb A1 c group was higher than that in the non diabetic group(P<0.05),but there was no significant difference between the high Hb A1 c group and the low Hb A1 c group(P>0.05),and the serum LDL-C level in the low Hb A1 c group was not statistically significant compared with the non diabetic group(P>0.05).7.The HOMA-IR in the high Hb A1 c group was significantly higher than that in the low Hb A1 c group and the non diabetic group(P<0.05),but there was no significant difference in HOMA-IR between the low Hb A1 c group and the non diabetic group(P>0.05).8.The body mass index(BMI)of the patients in the high Hb A1 c group and the low Hb A1 c group was higher than that in the non diabetic group(P<0.05),and the level of BMI in the high Hb A1 c group was higher than that in the low Hb A1 c group(P<0.05).9.There was no significant difference in serum thyroid stimulating hormone(TSH)level between the three groups(P>0.05).10.Linear correlation analysis showed that HOMA-IR was positively associated with the serum TSH levels in the non-DM group as well as in the DM group.Among patients with diabetes,we found positive relationships between HOMA-IR and TSH levels in the high-Hb A1 c group and in the low-Hb A1 c group.11.Fisher Z-transformation showed a statistical significance of r coefficient in the diabetic group and the high Hb A1 c group compared to the non diabetic grout and the low Hb A1 c group(P<0.05).12.Taking 50 y,60yand70y,all subjects were divided into four groups,and the correlation between TSH and HOMA-IR was analysised.The results showed that there was a positive linear correlation between serum TSH level and HOMA-IR in all the four groups.13.After adjustment for the age and sex and other confounding factors with multiple regression analysis,it was found that the level of serum TSH were independently related to HOMA-IR in the three groups,and BMI was also independently related to HOMA-IR.14.All subjects were divided into three groups by TSH three score method,and HOMA-IR of each group was compared.The results showed that the HOMA-IR in the high TSH group was higher than that in the low TSH group and the middle TSH group,while the HOMA-IR in the middle TSH group was higher than that in the low TSH group(P<0.05).15.Taking 24kg/m2 and 28kg/m2 as the cut-off points,all subjects were divided into three groups,and the correlation between TSH and HOMA-IR was analysised.The results showed that there was a positive linear correlation between serum TSH level and HOMA-IR in all the three groups.And in the group of BMI>28kg/ m2(in the obese patients with type 2 diabetes)the correlation between TSH and HOMA-IR was stronger.Conclusions:It was found in this study that serum TSH levels were independently associated with insulin resistance,and the correlation was stronger in type 2 diabetic patients with poor blood glucose control and obese. |
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