Jun Ji Eun, Jin Sang-Man, Jee Jae Hwan, Bae Ji Cheol, Hur Kyu Yeon, Lee Moon-Kyu, Kim Sun Wook, Kim Jae Hyeon
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Endocrine. 2017 Mar;55(3):944-953. doi: 10.1007/s12020-016-1221-1. Epub 2017 Jan 2.
Thyroid function is known to influence glucose metabolism, and thyroid-stimulating hormone is the most useful parameter in screening for thyroid dysfunction. Therefore, the aim of this study was to investigate the incidence of type 2 diabetes according to baseline thyroid-stimulating hormone level and thyroid-stimulating hormone change in euthyroid subjects.
We identified and enrolled 17,061 euthyroid subjects without diabetes among participants who had undergone consecutive thyroid function tests between 2006 and 2012 as a part of yearly health check-up program. Thyroid-stimulating hormone changes were determined by subtracting baseline thyroid-stimulating hormone level from thyroid-stimulating hormone level at 1 year before diagnosis of diabetes or at the end of follow-up in subjects who did not develope diabetes.
During 84,595 person-years of follow-up, there were 956 new cases of type 2 diabetes. Cox proportional hazards models showed the risk of incident type 2 diabetes was significantly increased with each 1 μIU/mL increment in TSH after adjustment for multiple confounding factors (hazard ratio = 1.13, 95% confidence interval: 1.07-1.20, P < 0.001). Compared with individuals in the lowest tertile (-4.08 to 0.34 μIU/mL), those in the highest thyroid-stimulating hormone change tertile (0.41-10.84 μIU/mL) were at greater risk for incident type 2 diabetes (hazard ratio = 1.25, 95% confidence interval: 1.05-1.48, P for trend = 0.011). However, baseline thyroid-stimulating hormone level and tertile were not associated with the risk for diabetes.
Prominent increase in thyroid-stimulating hormone concentration can be an additional risk factor for the development of type 2 diabetes in euthyroid subjects.
已知甲状腺功能会影响葡萄糖代谢，促甲状腺激素是筛查甲状腺功能障碍最有用的参数。因此，本研究旨在根据甲状腺功能正常受试者的基线促甲状腺激素水平和促甲状腺激素变化情况，调查2型糖尿病的发病率。
在2006年至2012年期间作为年度健康检查项目一部分接受连续甲状腺功能测试的参与者中，我们识别并纳入了17061名无糖尿病的甲状腺功能正常受试者。促甲状腺激素变化通过在糖尿病诊断前1年或未患糖尿病受试者随访结束时的促甲状腺激素水平减去基线促甲状腺激素水平来确定。
在84595人年的随访期间，有956例2型糖尿病新发病例。Cox比例风险模型显示，在调整多个混杂因素后，促甲状腺激素每增加1 μIU/mL，2型糖尿病发病风险显著增加（风险比=1.13，95%置信区间：1.07-1.20，P<0.001）。与促甲状腺激素变化最低三分位数（-4.08至0.34 μIU/mL）的个体相比，促甲状腺激素变化最高三分位数（0.41-10.84 μIU/mL）的个体发生2型糖尿病的风险更高（风险比=1.25，95%置信区间：1.05-1.48，趋势P=0.011）。然而，基线促甲状腺激素水平和三分位数与糖尿病风险无关。
促甲状腺激素浓度显著升高可能是甲状腺功能正常受试者发生2型糖尿病的一个额外风险因素。
