Zhongguo quanke yixue (Mar 2022)

Association between Subclinical Hypothyroidism and Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus

  • ZHAO Lei, LI Ruqiang, YUAN Mingxia

DOI
https://doi.org/10.12114/j.issn.1007-9572.2021.02.128
Journal volume & issue
Vol. 25, no. 09
pp. 1113 – 1118

Abstract

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BackgroundCardiac autonomic neuropathy (CAN) is a common and severe chronic diabetic complication, whose association with thyroid function has rarely been reported.ObjectiveTo investigate the association between subclinical hypothyroidism and CAN in type 2 diabetes mellitus (T2DM) .MethodsWe performed a retrospective analysis of 564 outpatients and hospitalized patients with T2DM recruited from Beijing Friendship Hospital, Capital Medical University from October 2019 to October 2020. Baseline characteristics, physical and laboratory examination results were collected. Ewing test was performed to identify CAN. The association between subclinical hypothyroidism and CAN was assessed using the Pearson correlation coefficient and Spearman's rank coefficient of correlation. Factors associated with CAN in T2DM were identified using multivariate, stepwise logistic regression.ResultsOne hundred and twenty-nine subjects (22.9%) were found with CAN, and other 435 without. Subclinical hypothyroidism was detected in 84 cases (14.9%) , including 36 with CAN and 48 without. The prevalence of subclinical hypothyroidism in those with CAN〔28.0% (36/129) 〕 was higher than that of those without〔11.0% (48/435) 〕 (χ2=22.346, P<0.001) . For those with CAN, the ratio between maximum and minimum R-R intervals during the Valsalva maneuver demonstrated a negative correlation with the duration of T2DM, glycated hemoglobin, fasting plasma glucose, low-density lipoprotein cholesterol, triacylglycerol, high-sensitivity C-reactive protein, thyroid-stimulating hormone and urine albumin-to-creatinine ratio, while it demonstrated a positive correlation with the diastolic blood pressure (P<0.05) . The multivariate, stepwise logistic regression analysis revealed that subclinical hypothyroidism〔OR=1.717, 95%CI (1.246, 2.365) 〕was independently associated with increased risk of CAN in T2DM (P<0.05) .ConclusionIn type 2 diabetes patients, the level of TSH may be related to CAN, and subclinical hypothyroidism may be an independent associated factor of CAN.

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