Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Diabetes Metab Res Rev. 2023 Sep;39(6):e3639. doi: 10.1002/dmrr.3639. Epub 2023 Apr 3.
Diabetic retinopathy (DR) can occur even in well-controlled type 2 diabetes, suggesting residual risks of DR in this population. In particular, we investigated the combined effect of thyroid function and glycaemic control assessed by an emerging metric, time in range (TIR) with DR.
In this cross-sectional study, a total of 2740 euthyroid patients with type 2 diabetes were included. Thyroid indicators, including thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, thyroid peroxidase antibody and thyroglobulin antibody, were measured. TIR was measured using continuous glucose monitoring data.
Overall, the multivariable-adjusted odds ratios (ORs) for DR across ascending tertiles of TSH were 1.00 (reference), 1.06 (95% confidence interval [CI] 0.85-1.32), and 1.48 (95% CI 1.19-1.85). Even in well-controlled participants who achieved a TIR target of >70% (n = 1449), the prevalence of DR was 23.8%, which was significantly related to TSH (OR = 1.54, 95% CI 1.12-2.12, highest vs. lowest TSH tertile). Participants were then classified into 6 groups by the joint categories of TIR (>70%, ≤70%) and TSH (tertiles), and the multivariable-adjusted ORs for DR were highest in TIR ≤70% and the highest TSH tertile group (OR = 1.96, 95% CI 1.41-2.71) when compared with the TIR >70% and the lowest TSH tertile group.
In type 2 diabetic patients with well-controlled glycaemic status, higher TSH within the normal range was associated with an increased risk of DR. The combination of suboptimal TSH and TIR further increased the risk of DR.
即使在 2 型糖尿病得到良好控制的情况下，也可能发生糖尿病视网膜病变（DR），这表明该人群仍存在 DR 的残余风险。特别是，我们研究了新兴指标——时间在目标范围内（TIR）与 DR 联合评估甲状腺功能和血糖控制对 DR 的综合影响。
在这项横断面研究中，共纳入了 2740 名甲状腺功能正常的 2 型糖尿病患者。测量了甲状腺指标，包括促甲状腺激素（TSH）、游离三碘甲状腺原氨酸、游离甲状腺素、甲状腺过氧化物酶抗体和甲状腺球蛋白抗体。使用连续血糖监测数据测量 TIR。
总体而言，TSH 升高组中，DR 的多变量调整比值比（OR）分别为 1.00（参考）、1.06（95%置信区间 [CI] 0.85-1.32）和 1.48（95% CI 1.19-1.85）。即使在达到 TIR 目标>70%（n=1449）的血糖控制良好的参与者中，DR 的患病率仍为 23.8%，且与 TSH 显著相关（OR=1.54，95% CI 1.12-2.12，最高 TSH 三分位组）。然后，根据 TIR（>70%、≤70%）和 TSH（三分位）的联合分类，将参与者分为 6 组，与 TIR>70%和 TSH 最低三分位组相比，TIR≤70%和 TSH 最高三分位组的 DR 多变量调整 OR 最高（OR=1.96，95% CI 1.41-2.71）。
在血糖控制良好的 2 型糖尿病患者中，正常范围内较高的 TSH 与 DR 风险增加相关。TSH 不理想与 TIR 结合进一步增加了 DR 的风险。
