Zhang Chenyu, Liu Aihua, Teng Weiping, Yang Wenying, Li Jing, Shan Zhongyan
Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Shenyang, Liaoning, 110001, P. R. China.
Department of Endocrinology, Peking University Third Hospital, Beijing, 100191, China.
J Endocrinol Invest. 2025 Feb;48(2):419-433. doi: 10.1007/s40618-024-02463-7. Epub 2024 Oct 14.
While metformin is known to regulate thyroid stimulating hormone (TSH) levels, the effects of acarbose on thyroid function remain unreported. Our study was designed to evaluate the impact of acarbose and metformin on thyroid function and thyroid hormone sensitivity in type 2 diabetic patients.
In the MARCH study, 788 patients with type 2 diabetes were randomly assigned to treat with acarbose (300 mg) or metformin (1,500 mg) for 48 weeks. Thyroid function was assessed at baseline, 24 weeks, and 48 weeks, and the thyroid feedback quantile index (TFQI) and parameterized thyroid feedback quantile index (PTFQI) were calculated. Generalized estimating equations adjusted for confounders were used to analyze changes over time.
Eighty-four patients with subclinical hypothyroidism (SCH) exhibited a decrease in TSH levels (p = 0.001) with no significant differences between the two treatment groups (p = 0.460). Both TFQI (p = 0.029) and PTFQI (p < 0.001) also decreased over time. Mediation analysis revealed that these change over time were not mediated by BMI (all p < 0.05). Among the 489 euthyroid subjects, no significant changes in TSH levels were observed (p > 0.05). Stratification by baseline TSH levels revealed significant increases in TSH, TFQI, and PTFQI (all p < 0.05) in the normal-low TSH group and significant decreases in PTFQI (all p < 0.05) in the normal-high TSH group after treatment with acarbose and metformin.
Acarbose and metformin have similar buffering effects on TSH levels, the TFQI and the PTFQI. In patients with lower TSH levels, acarbose and metformin do not further decrease TSH levels.
ChiCTR-TRC-08000231.
虽然已知二甲双胍可调节促甲状腺激素（TSH）水平，但阿卡波糖对甲状腺功能的影响尚未见报道。我们的研究旨在评估阿卡波糖和二甲双胍对2型糖尿病患者甲状腺功能及甲状腺激素敏感性的影响。
在MARCH研究中，788例2型糖尿病患者被随机分配接受阿卡波糖（300毫克）或二甲双胍（1500毫克）治疗48周。在基线、24周和48周时评估甲状腺功能，并计算甲状腺反馈分位数指数（TFQI）和参数化甲状腺反馈分位数指数（PTFQI）。使用针对混杂因素进行调整的广义估计方程来分析随时间的变化。
84例亚临床甲状腺功能减退（SCH）患者的TSH水平降低（p = 0.001），两个治疗组之间无显著差异（p = 0.460）。TFQI（p = 0.029）和PTFQI（p < 0.001）也随时间降低。中介分析显示，这些随时间的变化不是由体重指数介导的（所有p < 0.05）。在489例甲状腺功能正常的受试者中，未观察到TSH水平有显著变化（p > 0.05）。按基线TSH水平分层显示，在使用阿卡波糖和二甲双胍治疗后，正常低TSH组的TSH、TFQI和PTFQI显著升高（所有p < 0.05），正常高TSH组的PTFQI显著降低（所有p < 0.05）。
阿卡波糖和二甲双胍对TSH水平、TFQI和PTFQI具有相似的缓冲作用。在TSH水平较低的患者中，阿卡波糖和二甲双胍不会进一步降低TSH水平。
ChiCTR - TRC - 08000231。
