High-normal serum thyrotropin levels and increased glycemic variability in type 2 diabetic patients
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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.
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.
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.
High-normal serum TSH is a significant additional risk factor for increased glycemic variability in type 2 diabetic patients.
KeywordsGlycemic variability Thyrotropin Type 2 diabetes
Insulin sensitivity index recommended by Matsuda
Mean amplitude of glycemic excursions
Mean of daily differences
Standard deviation of glucose
- 24-h MG
24-h mean glucose
Body mass index
Systolic blood pressure
Diastolic blood pressure
High-density lipoprotein cholesterol
Low-density lipoprotein cholesterol
Glycosylated hemoglobin A1c
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).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
Each patient agreed to participate in the study and signed the informed consent form.
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