Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Eur J Endocrinol. 2022 Sep 30;187(5):S35-S46. doi: 10.1530/EJE-22-0523. Print 2022 Nov 1.
Few prospective studies have assessed whether individuals with subclinical thyroid dysfunction are more likely to develop diabetes, with conflicting results. In this study, we conducted a systematic review of the literature and an individual participant data analysis of multiple prospective cohorts to investigate the association between subclinical thyroid dysfunction and incident diabetes.
We performed a systematic review of the literature in Medline, Embase, and the Cochrane Library from inception to February 11, 2022. A two-stage individual participant data analysis was conducted to compare participants with subclinical hypothyroidism and subclinical hyperthyroidism vs euthyroidism at baseline and the adjusted risk of developing diabetes at follow-up.
Among 61 178 adults from 18 studies, 49% were females, mean age was 58 years, and mean follow-up time was 8.2 years. At the last available follow-up, there was no association between subclinical hypothyroidism and incidence of diabetes (odds ratio (OR) = 1.02, 95% CI: 0.88-1.17, I2 = 0%) or subclinical hyperthyroidism and incidence of diabetes (OR = 1.03, 95% CI: 0.82-1.30, I2 = 0%), in age- and sex-adjusted analyses. Time-to-event analysis showed similar results (hazard ratio for subclinical hypothyroidism: 0.98, 95% CI: 0.87-1.11; hazard ratio for subclinical hyperthyroidism: 1.07, 95% CI: 0.88-1.29). The results were robust in all sub-group and sensitivity analyses.
This is the largest systematic review and individual participant data analysis to date investigating the prospective association between subclinical thyroid dysfunction and diabetes. We did not find an association between subclinical thyroid dysfunction and incident diabetes. Our results do not support screening patients with subclinical thyroid dysfunction for diabetes.
Evidence is conflicting regarding whether an association exists between subclinical thyroid dysfunction and incident diabetes. We therefore aimed to investigate whether individuals with subclinical thyroid dysfunction are more prone to develop diabetes in the long run as compared to euthyroid individuals. We included data from 18 international cohort studies with 61 178 adults and a mean follow-up time of 8.2 years. We did not find an association between subclinical hypothyroidism or subclinical hyperthyroidism at baseline and incident diabetes at follow-up. Our results have clinical implications as they neither support screening patients with subclinical thyroid dysfunction for diabetes nor treating them in the hope of preventing diabetes in the future.
很少有前瞻性研究评估亚临床甲状腺功能障碍患者是否更易发生糖尿病，且研究结果相互矛盾。本研究通过系统综述和对多个前瞻性队列的个体参与者数据进行分析，旨在调查亚临床甲状腺功能障碍与新发糖尿病之间的关联。
我们在 Medline、Embase 和 Cochrane 图书馆中对文献进行了系统综述，检索时间从建库至 2022 年 2 月 11 日。我们进行了两阶段的个体参与者数据分析，比较了基线时患有亚临床甲状腺功能减退症和亚临床甲状腺功能亢进症与甲状腺功能正常的参与者，并比较了随访时发生糖尿病的调整风险。
在来自 18 项研究的 61178 名成年人中，49%为女性，平均年龄为 58 岁，平均随访时间为 8.2 年。在最后一次可获得的随访中，亚临床甲状腺功能减退症与糖尿病的发生率之间没有关联（比值比[OR] = 1.02，95%置信区间[CI]：0.88-1.17，I2 = 0%），亚临床甲状腺功能亢进症与糖尿病的发生率之间也没有关联（OR = 1.03，95%CI：0.82-1.30，I2 = 0%），在年龄和性别调整分析中。时间事件分析也得到了类似的结果（亚临床甲状腺功能减退症的风险比：0.98，95%CI：0.87-1.11；亚临床甲状腺功能亢进症的风险比：1.07，95%CI：0.88-1.29）。所有亚组和敏感性分析的结果均稳健。
这是迄今为止关于亚临床甲状腺功能障碍与糖尿病之间前瞻性关联的最大规模的系统综述和个体参与者数据分析。我们没有发现亚临床甲状腺功能障碍与新发糖尿病之间存在关联。我们的结果不支持筛查亚临床甲状腺功能障碍患者是否患有糖尿病。
关于亚临床甲状腺功能障碍与新发糖尿病之间是否存在关联的证据存在争议。因此，我们旨在调查亚临床甲状腺功能障碍患者与甲状腺功能正常者相比，长期来看是否更容易发生糖尿病。我们纳入了来自 18 项国际队列研究的数据，共 61178 名成年人，平均随访时间为 8.2 年。我们没有发现基线时的亚临床甲状腺功能减退症或亚临床甲状腺功能亢进症与随访时的糖尿病之间存在关联。我们的研究结果具有临床意义，因为它们既不支持筛查亚临床甲状腺功能障碍患者是否患有糖尿病，也不支持对其进行治疗，以期望未来预防糖尿病。
