Association Between Changes in Thyroid Hormones and Incident Type 2 Diabetes: A Seven-Year Longitudinal Study
Association Between Changes in Thyroid Hormones and Incident Type 2 Diabetes: A Seven-Year Longitudinal Study
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DOI：
10.1089/thy.2016.0171
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发表时间：
2017-01-01
期刊：
影响因子：
6.6
通讯作者：
Kim, Jae Hyeon
中科院分区：
文献类型：
--
作者：
Jun, Ji Eun;Jee, Jae Hwan;Kim, Jae Hyeon
背景：甲状腺激素是葡萄糖稳态的重要调节因子。然而，甲状腺激素在参考范围内与2型糖尿病（T2 DM）之间的关联仍不清楚。本研究的目的是根据促甲状腺激素（TSH）和甲状腺激素的基线水平和变化来阐明T2 DM的发病率（游离甲状腺素和三碘甲状腺原氨酸）在甲状腺功能正常的受试者。在2006年至2012年期间通过年度健康检查计划连续进行甲状腺功能测试的参与者中，本研究入组了6235例甲状腺功能正常的非T2 DM受试者（3619例男性和2616例女性）。每种激素的变化是通过从随访结束时或糖尿病诊断前一年的水平减去基线值来计算的。结果：在25,692人年的随访期间，有229例新的T2 DM病例。在考克斯比例风险模型中，对包括HbA 1c和空腹血糖在内的潜在混杂因素进行充分校正后，TSH变化最高三分位数的个体（2.5-4.2 mu IU/mL）发生T2 DM的风险更大（风险比[HR] = 1.44 [置信区间（CI）1.04-1.98]，p = 0.027）。同时，三碘甲状腺原氨酸的最高三分位数发生变化（16.3-104.7 ng/dL）和游离甲状腺素变化（0.2-1.6 ng/dL）具有预防糖尿病的保护作用（HR = 0.60 [CI 0.43-0.85]，p = 0.002和HR=0.34 [CI 0.24-0.48]，p < 0.001，与最低三分位数（分别为-76.5至-1.8 ng/dL和-0.6至0.0 ng/dL）相比，当将每种激素作为连续变量进行分析时，这些关联仍然显着。然而，TSH和甲状腺激素的基线水平或三分位数与糖尿病的风险无关。结论：TSH和甲状腺激素的个体变化，即使在正常参考范围内，也是T2 DM事件的额外风险因素。
Background: Thyroid hormones are important regulators of glucose homeostasis. However, the association between thyroid hormones within the reference range and type 2 diabetes mellitus (T2DM) remains unclear. The aim of this study was to clarify the incidence of T2DM according to the baseline levels and changes of thyrotropin (TSH) and thyroid hormones (free thyroxine and triiodothyronine) in euthyroid subjects.Methods: Among the participants who consecutively underwent thyroid function tests between 2006 and 2012 through a yearly health checkup program, 6235 euthyroid subjects (3619 men and 2616 women) without T2DM were enrolled in the study. The change in each hormone was calculated by subtracting the baseline value from the level at the end of follow-up or one year before the diagnosis of diabetes.Results: During 25,692 person-years of follow-up, there were 229 new cases of T2DM. After full adjustment for potential confounders including HbA1c and fasting glucose in Cox proportional hazards models, the individuals in the highest tertile of TSH change (2.5-4.2 mu IU/mL) had a greater risk of incident T2DM (hazard ratio [HR] = 1.44 [confidence interval (CI) 1.04-1.98], p = 0.027) in comparison with individuals in the lowest tertile (-4.1 to -0.5 mu IU/mL). Simultaneously, the highest tertile of triiodothyronine change (16.3-104.7 ng/dL) and free thyroxine change (0.2-1.6 ng/dL) conferred protective effects against diabetes (HR = 0.60 [CI 0.43-0.85], p = 0.002, and HR=0.34 [CI 0.24-0.48], p < 0.001, respectively) compared with those in the lowest tertile (-76.5 to -1.8 ng/dL and -0.6 to 0.0 ng/dL, respectively). These associations remained significant when each of the hormones was analyzed as a continuous variable. However, baseline levels or tertiles of TSH and thyroid hormones were not associated with the risk of diabetes.Conclusions: Individual changes in TSH and thyroid hormones, even within the normal reference range, were an additional risk factor of incident T2DM.