The Correlation Study Of Insulin Resistance And Thyroid Nodules Among406Cases Of Diabetics

Objective: Thyroid diseases and diabetes are both common diseases. Early studyfound that thyroid nodules were closely correlated with obesity and metabolic syndrome,while the metabolic syndrome has something with insulin resistance. The study aboutthe relationship of insulin resistance and thyroid nodules of diabetics is less. In order todiscuss the correlation between insulin resistance and thyroid nodules through analyzingthe prevalence of thyroid nodules and its correlation among hospitalized diabeticpatients.Methods: Select406diabetic patients with standard bread meal test in the departmentof endocrinology of the Second Affiliated Hospital of Dalian Medical University fromNovember2012to April2013, and divide them into the nodule group and non-nodulegroup according to the presence or absence of thyroid nodules, and compare thedifferences of gender, age, waist circumference, hip circumference, WHR, BMI, fastingand postprandial1h,2h blood glucose,2hC peptide,2h insulin, HbA1C, IAA, GAD,TSH, FT4, Tg-Ab, Tpo-Ab, TG, TC, HDL, LDL, APOa, APOb, hypertension and fattyliver condition between two groups.Then divide them into subgroups by sex, age (50years and younger,51to60years,61to70years,71years old and above), fasting plasma glucose (~6.0mmol/L,6.1~6.9mmol/L,7.0~mmol/L), BMI (~23.9,24.0~27.9,28.0~) and HOMA-IR(0~1,1~2,2~3,3~4,4~), and understand the incidence of thyroid nodules, and performmultifactor Logistic regression analysis at the same time.Results:1. There were301thyroid nodules among406diabetics, and the prevalence ofthyroid nodules was74.1%; among which male diabetics were222, and there were144thyroid nodules, the prevalence was64.9%; female diabetics were184, and there were157thyroid nodules, the prevalence was85.3%, comparing the prevalence betweenmales and females found that the ratio of males to females was1:1.31, and the numberof females was higher than that of males, and the difference was statistically significant. 2. The proportion of BMI, FPG, HOMA-IR, age of onset and hypertension in thethyroid nodule group was higher than that of the non-nodule group, and the differencewas statistically significant.3. The prevalence of males was a little higher than that of females in age group below50years old, while the prevalence of females was higher than that of males in other agegroups, and comparing the prevalence of males and females between51to60years and61to70years old found that the difference was statistically significant. No mattermales and females, the prevalence of thyroid nodules increased with age among groups.Compared with age group below50years old, the prevalence of thyroid nodules in agegroups of61to70years and71years old and above was obviously increased, and thedifference was statistically significant, while compared with age group of51to60yearsold, the result of age group of71years old and above also had significant differencestatistically.4. After grouping according to different BMI, the prevalence of thyroid nodulesincreased with BMI, and the difference was statistically significant. Compared withBMI≤23.9kg/m2group, the prevalence of thyroid nodules in group of BMI≥28.0kg/m2was obviously increased and the difference was statistically significant, while thedifference between overweight group and obesity group was not statistically significant.5. Dividing FBG into3groups according to fasting blood glucose≤6.0mmol/L,6.1-6.9mmol/L,≥7.0mmol/L, the prevalence of thyroid nodules increased with fastingblood glucose and the difference was statistically significant. Compared with group offasting blood glucose≤6.0mmol/L, the prevalence of nodules in group of fasting bloodglucose≥7.0mmol/L was obviously higher, and the difference was statisticallysignificant.6. Dividing them into five groups according to the insulin resistance index0~1,1~2,2~3,3~4, above4, the prevalence of thyroid nodules increased with insulin resistanceindex, and the difference was statistically significant. In comparison between groups,we found that the prevalence of the diabetic groups with insulin resistance index3~4and above4was obviously increased compared with the diabetic groups of insulinresistance index0~1, and the difference was statistically significant.7. We performed multifactor Logistic regression analysis by selecting the presence orabsence of thyroid nodules as the dependent variable Y, and age, gender, hypertension,BMI, fasting blood glucose and HOMA-IR as the independent variables X. Applying the backwardlk method, we found that thyroid nodules were negatively correlated withgender, and were positively correlated with age, fasting blood glucose and BMI, buthad no significant correlation with HOMA-IR (P>0.05), which showed that age,gender, fasting glucose and BMI were the independent risk factors of thyroid nodulesin patients with diabetes.Conclusion:1. The prevalence of thyroid nodules among female diabetics is muchhigher, and the prevalence of thyroid nodules increases with age, for the aged diabeticsof60years old and above, their prevalence of thyroid nodules is at even greater risk.2. The prevalence of thyroid nodules increased with BMI and fasting blood glucose,and the prevalence of thyroid nodules in obese diabetics is higher than that in diabeticswith normal body weight. The prevalence of thyroid nodules of diabetics with poorfasting blood glucose control is higher than that of diabetics with fasting blood glucosecontrolling in the normal range.3. The prevalence of thyroid nodules increased with HOMA-IR, and compared withdiabetics of HOMA-IR<1, the prevalence of thyroid nodules of diabetics withHOMA-IR>3is increased.4. Age, fasting glucose, gender and BMI were the independent risk factors of thyroidnodules in diabetics.