Adults with type 2 diabetes, high TSH have increased risk for diabetic retinopathy
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Key takeaways:
- Adults with type 2 diabetes had a higher risk for diabetic retinopathy if they had a higher TSH level.
- The highest diabetic retinopathy risk was observed for adults with high TSH and a lower time in range.
Adults with type 2 diabetes and a high thyroid-stimulating hormone level are more likely to develop diabetic retinopathy, and low time in range further increases the risk for diabetic retinopathy, according to study data.
“Thyroid dysfunction and diabetes mellitus often coexist and are closely linked,” Jian Zhou, MD, PhD, of the department of endocrinology and metabolism at Shanghai Sixth People’s Hospital in China, and colleagues wrote in a study published in Diabetes/Metabolism Research and Reviews. “Evidence indicates that the two diseases may share a few common glucose and lipid metabolism signaling pathways and interact with each other through insulin resistance and inflammatory factors. To the best of our knowledge, there have been no studies exploring the combined effect of thyroid function and glycemic control on the development of diabetes complication. In the present study, we found that the risk of diabetic retinopathy was increased when both higher TSH and lower time in range were present.”
Researchers conducted a cross-sectional study of 2,740 adults aged 18 to 80 years with type 2 diabetes admitted to Shanghai Sixth People’s Hospital from June 2019 to December 2021 (65% men; median age, 61 years). Participants used a continuous glucose monitoring system during hospitalization. Diabetic retinopathy was assessed through fundus photography. Participants were categorized as having no diabetic retinopathy, mild nonproliferative diabetic retinopathy, moderate nonproliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy.
Twenty-nine percent of participants were diagnosed with some form of diabetic retinopathy. The prevalence of diabetic retinopathy among adults with a time in range of greater than 70% was 23.8%. Adults with diabetic retinopathy had lower free triiodothyronine levels and higher TSH levels than those without diabetic retinopathy.
After dividing the cohort into tertiles by TSH levels, adults with the highest TSH were more likely to develop diabetic retinopathy than those in the lowest TSH tertile (adjusted OR = 1.48; 95% CI, 1.19-1.85). The association was similar regardless of whether adults had a time in range greater than or less than 70%.
Participants in the highest TSH tertile were more likely to develop mild nonproliferative diabetic retinopathy (aOR= 1.39; 95% CI, 1.08-1.78), moderate nonproliferative diabetic retinopathy (aOR= 1.84; 95% CI, 1.08-3.14) and vision-threatening diabetic retinopathy (aOR= 1.64; 95% CI, 1.05-2.57) than those in the lowest tertile. Among adults with a time in range of more than 70%, higher TSH levels were associated with increased odds for moderate diabetic retinopathy and vision-threatening diabetic retinopathy, whereas among those with a time in range of 70% or less, higher TSH was associated only with higher odds for mild diabetic retinopathy.
Adults were also divided into joint groups by both time in range and TSH tertile. After multivariable adjustments, the risk for diabetic retinopathy was highest among adults with a time in range of 70% or less who were in the highest TSH tertile (aOR = 1.96; 95% CI, 1.41-2.71).
“In clinical practice, more attention should be paid to the potential effects of both TSH and time in range for better management of diabetic retinopathy,” the researchers wrote. “Well-designed longitudinal studies with TSH measurements over different time points are warranted to further confirm the role of TSH in risk management of diabetes complications and explore the reference range for ‘normal’ TSH in the future.”
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