The Relationships Between Thyroid Function And Diabetic Retinopathy And Nephropathy In Type 2 Diabetes

Objective:To analyze the correlation between thyroid function and the retinopathy and nephropathy and to explore the effect of thyroid hormone on the occurrence and development of microangiopathy in type 2 diabetes mellitus.Methods:A total of 1423 patients with type 2 diabetes mellitus admitted to the endocrinology department of 2ndAffiliated Hospital of Jilin University from April 2015 to September 2016 were divided into Subclinical thyroid dysfunction group(n = 191),clinical thyroid dysfunction group(n = 53)and normal control group(n= 1179),clinical data(include age,sex,duration of diabetes,hypertension,smoking),laboratory examination results(include TSH,FT3,FT4,Urinary albumin,Urinary albumin creatinine ratio,serum creatinine,glomerular filtration rate,glycosylated hemoglobin,lipids,and fasting C-peptide)and ophthalmoscopy results of these subjects were collected and analyzed retrospectively.All the data were analyzed by SPSS21.0 for statistical analysis.P < 0.05 showed statistically significant.Results:The subclinical thyroid dysfunction group had a higher prevalence of diabetic retinopathy than the euthyroid group(49.2% vs 38.2%,p=0.004).In diabetic retinopathy subjects,the proportion of proliferative retinopathy in subclinical thyroid dysfunction group was higher than that in normal group(52.1% vs36.2%,p=0.004);The prevalence of diabetic nephropathy in subclinical thyroid dysfunction group was higher than that in normal group(37.2% vs 15.3%,p = 0.000).In diabetic nephropathy,the glomerular filtration rate in subclinical abnormal function group was lower than that in normal group,and the renal function stage in chronic renal disease was higher than that in normal function group(2.18 vs 1.62,p=0.000).After adjustment for gender,age,duration,smoking,hypertension,hyperlipidemia,Hb A1 c,and fasting C-peptide,Multivariate logistic regression analysis showed that Subclinicalthyroid dysfunction were independent risk factors for diabetic retinopathy(OR,1.60;95% confidence interval,1.159-2.227;p=0.0044)and nephropathy(OR,3.7;95% confidence interval,2.581-5.305;p<0.0001).The prevalence of diabetic retinopathy was significantly lower in patients with abnormal thyroid function(34.0% vs 38.2%,p = 0.000).In diabetic retinopathy,the proportion of proliferative retinopathy of thyroid dysfunction group was not statistically different from that of normal thyroid function group.However,after multivariate logistic regression adjustment of confounding factors,there was no clear correlation between thyroid function abnormality and retinopathy.The thyroid dysfunction group had a higher prevalence of diabetic nephropathy than the euthyroid group(28.3% vs 15.3%,p=0.000),The rate of glomerular filtration rate in diabetic nephropathy was lower than that in normal group and the renal function stage of chronic kidney disease was higher than that in normal group(2.07,1.62,p = 0.03),and the results were statistically significant.A multifactorial logistic regression adjusted confounders found that thyroid dysfunction remained an independent risk factor for diabetic nephropathy(OR,2.104;95% confidence interval,1.1-4.024;p =0.0246).Conclusions:In type 2 diabetes,subclinical thyroid dysfunction increases the prevalence of diabetic retinopathy and diabetic nephropathy and aggravates diabetic retinopathy and diabetic nephropathy,Thyroid dysfunction increased the prevalence of diabetic nephropathy,and increase aggravated diabetic nephropathy,but no clear correlation with diabetic retinopathy.