A Clinical Study Of Type 1 Diabetes Mellitus With Thyroid Dysfunction

ObjectivePatients with type 1 diabetes mellitus(T1DM)have an increased risk of autoimmune thyroid disease and thyroid dysfunction(TD).The co-occurrence of T1DM and TD will affect glucose and lipid metabolism and the progress of diabetes-related complications,which requires appropriate screening and treatment for TD in patients with T1DM.This study analyzes the epidemiological and clinical characteristics of T1DM patients with TD,and explores the impact of subclinical hypothyroidism on blood lipids,renal function and urine protein related indexes,so as to provide decision-making basis for the clinical management of TD in T1DM patients.MethodsThis study was a single-center retrospective database study.We used the data from the electronic medical record database of Peking Union Medical College Hospital for statistical analysis.We collected demographic,clinical diagnosis,laboratory examination and medical history information of all inpatients and outpatients who were diagnosed with T1DM of Peking Union Medical College Hospital from 2013 to 2020.First,we analyzed the prevalence of TD in inpatients and outpatients diagnosed with T1DM,respectively.We then compared the prevalence of TD in patients with classical T1DM and those with Latent Autoimmune Diabetes in Adults(LADA).Next,we analyzed hypothyroidism related factors in T1DM patients.Finally,we analyzed the differences in blood lipids,renal function and urinary protein related indexes between the classic T1DM patients with subclinical hypothyroidism and those with normal thyroid function test results.ResultsThe prevalence of hypothyroidism and hyperthyroidism were 13.9%and 3.1%in hospitalized adult patients with T1DM,11%and 2.5%in hospitalized juvenile patients,8.9%and 1.2%in outpatient adult patients,and 3.8%and 0.8%in outpatient juvenile patients,respectively.There was no significant difference in the prevalence of TD between classical T1DM and LADA patients.Women,older age,and positive thyroid peroxidase and thyroglobulin antibodies were significantly associated with higher prevalence of hypothyroidism.Compared with classic T1DM patients with normal thyroid function test results,patients with subclinical hypothyroidism had higher serum low-density lipoprotein cholesterol and triglyceride levels,higher urine albumin-creatinine ratio and increased prevalence of proteinuria.There was no significant difference in the estimated glomerular filtration rate,or the changing rate of glomerular filtration rate and urine albumin-creatinine ratio in patients with classic T1DM with subclinical hypothyroidism and normal thyroid function test results.ConclusionsPatients with T1DM had a higher risk of developing clinical hypothyroidism than the general population.There was no significant difference in the proportion of TD in patients with classic T1DM and LADA.Women,older age,and positive thyroid antibodies were associated with an increased risk of hypothyroidism.Subclinical hypothyroidism in patients with T1DM may be associated with increased blood lipid and urinary protein.