Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza 2, Poznan, 60-834, Poland.
Endocrine. 2018 Jun;60(3):458-465. doi: 10.1007/s12020-018-1582-8. Epub 2018 Mar 30.
Type 1 diabetes mellitus (T1DM) is a disorder of insulin deficiency but with a wide range of hormones simultaneously disturbed. The study was performed to explore relation of free triiodothyronine (FT3) with metabolic control and occurrence of microangiopathic complications.
A total of 266 adult T1DM participants [56% men; 32 (interquartile range, IQR: 25-39) years and disease duration 13 (IQR: 8-19) years] in euthyroid state with negative history for hypothyroidism were included to the study. Participants were screened for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and FT3. Moreover, microangiopathic complications (retinopathy, diabetic kidney disease, peripheral and autonomic neuropathy), markers of metabolic control such as glycated hemoglobin (HbA) were evaluated.
A total of 114 (42.9%) people had diagnosed at least one microangiopathic complication. In multivariable linear regression higher HbA was statistically significant independent predictor of lower FT3 (β = -0.25; p < 0.0001) after adjustment for sex, T1DM duration, HbA, waist-to-hip ratio (WHR) (R = 0.15, p < 0.0001). Higher FT3 was simultaneously a predictor of lower prevalence of microangiopathy in multivariate logistic regression analysis (odds ratio, 0.51; 95% confidence interval, 0.27-0.98; p = 0.04) after an adjustment for: age, hypertension, HbA, WHR and total cholesterol (TC).
FT3 as tissue active hormone plays a clinically important role in T1DM people. The higher FT3 concentration is related to the lower prevalence of microangiopathy and better metabolic control of the disease in adult euthyroid people with T1DM.
1 型糖尿病（T1DM）是一种胰岛素缺乏症，但同时存在多种激素紊乱。本研究旨在探讨游离三碘甲状腺原氨酸（FT3）与代谢控制及微血管并发症发生的关系。
共纳入 266 例成年 T1DM 患者[56%为男性；32 岁（四分位间距，IQR：25-39 岁），病程 13 年（IQR：8-19 年）]，甲状腺功能正常，无甲状腺功能减退病史。对患者进行促甲状腺激素（TSH）、游离甲状腺素（FT4）和 FT3 筛查。此外，还评估了微血管并发症（视网膜病变、糖尿病肾病、周围和自主神经病变）、代谢控制标志物（糖化血红蛋白，HbA）等指标。
共有 114 例（42.9%）患者至少诊断出一种微血管并发症。在多变量线性回归中，校正性别、T1DM 病程、HbA、腰臀比（WHR）后，HbA 升高是 FT3 降低的独立显著预测因子（β=-0.25；p<0.0001）。在校正年龄、高血压、HbA、WHR 和总胆固醇（TC）后，FT3 升高同时是多变量逻辑回归分析中微血管病变低发生率的预测因子（比值比，0.51；95%置信区间，0.27-0.98；p=0.04）。
FT3 作为组织活性激素，在 T1DM 患者中具有重要的临床意义。在甲状腺功能正常的成年 T1DM 患者中，FT3 浓度越高，微血管病变的发生率越低，疾病的代谢控制越好。
