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High-normal serum thyrotropin levels and increased glycemic variability in type 2 diabetic patients

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Abstract

Purpose

High-normal thyrotropin (TSH) is related to reduced insulin sensitivity and may contribute to glycemic disorders in diabetes. We investigated the relationship between normal serum TSH levels and glycemic variability in euthyroid type 2 diabetic patients.

Methods

A total of 432 newly diagnosed type 2 diabetic patients with euthyroid function and normal serum TSH levels were recruited between March 2013 and February 2017. Insulin sensitivity was evaluated by the Matsuda index (ISIMatsuda) following a 75-g oral glucose tolerance test. Multiple glycemic variability indices, including the mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), and standard deviation of glucose (SD), were calculated from glucose data obtained with a continuous glucose monitoring system. Average glucose accessed by 24-h mean glucose (24-h MG) was also calculated.

Results

A normal serum TSH level was positively correlated with MAGE, MODD, SD, and 24-h MG (r = 0.206, 0.178, 0.186, and 0.132, respectively, p < 0.01). After adjusting for somatometric parameters, lipid profiles, ISIMatsuda, and HbA1c via multiple linear regression analysis, mean differences [B(95% CI)] in MAGE, MODD, SD, and 24-h MG between the patients in the lowest and highest quartiles of TSH levels were 0.128(0.031, 0.226), 0.085(0.022, 0.148), 0.039(0.001, 0.078), and 0.002(−0.264, 0.267) mmol/L, respectively. High-normal TSH was independently associated with MAGE, MODD, and SD, but not 24-h MG.

Conclusions

High-normal serum TSH is a significant additional risk factor for increased glycemic variability in type 2 diabetic patients.

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Abbreviations

TSH:

Thyrotropin

FT3:

Free triiodothyronine

FT4:

Free thyroxine

TPO-Ab:

Thyroperoxidase antibody

ISIMatsuda :

Insulin sensitivity index recommended by Matsuda

MAGE:

Mean amplitude of glycemic excursions

MODD:

Mean of daily differences

SD:

Standard deviation of glucose

24-h MG:

24-h mean glucose

BMI:

Body mass index

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

TC:

Total cholesterol

TG:

Triglyceride

HDLC:

High-density lipoprotein cholesterol

LDLC:

Low-density lipoprotein cholesterol

HbA1c:

Glycosylated hemoglobin A1c

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Funding

The study was supported by the Medical Research Projects of Nantong Technology Bureau (HS2012028, MS22015065) and the Medical Research Project of Health and Family Planning Commission of Jiangsu (QNRC2016408).

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    Authors and Affiliations

    1. Department of Endocrinology, The Second Affiliated Hospital of Nantong University, and First People’s Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China

      Jian-Bin Su, Li-Hua Zhao, Hai-Yan Huang, Feng Xu & Xue-Qin Wang

    2. Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, and First People’s Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China

      Xiu-Lin Zhang & Tong Chen

    3. Department of Geriatrics, The Second Affiliated Hospital of Nantong University, and First People’s Hospital of Nantong City, No. 6, Hai-er-xiang North Road, 226001, Nantong, China

      Hong-Li Cai

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    This study conformed to the guidelines of the Declaration of Helsinki, and the study procedures were reviewed and approved by the Medical Research Ethics Committee of Second Affiliated Hospital of Nantong University.

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    These authors contributed equally: Jian-Bin Su, Li-Hua Zhao.

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    Su, JB., Zhao, LH., Zhang, XL. et al. High-normal serum thyrotropin levels and increased glycemic variability in type 2 diabetic patients. Endocrine 61, 68–75 (2018). https://doi.org/10.1007/s12020-018-1591-7

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