Objective This study aimed to explore the relationship of thyroid function and glucose metabolism and to investigate the changes in thyroid function after National Metabolic Management Center (MMC) management in type 2 diabetic mellitus (T2DM). Methods A total of 2000 euthyroid participants from MMC in Shanghai General Hospital and a community physical examination were recruited. They were categorized into four groups: normal glucose tolerance (NGT, n = 132), prediabetes (N = 147), DM well‐controlled (T2DM with glycosylated hemoglobin [HbA1c] ≤ 7%, n = 505), and DM uncontrolled (T2DM with HbA1c > 7%, n = 1216). The parameters were compared among the groups and their changes before and after MMC follow‐up in DM uncontrolled group were observed. Results Free triiodothyronine (FT3) and free thyroxine (FT4) levels varied significantly among groups. FT3 and FT4 levels negatively correlated with HbA1c level (P < 0.05), and positively correlated with the estimated glucose disposal rate (eGDR) (P < 0.05). Following MMC management, blood glucose and insulin resistance in the DM uncontrolled group were dramatically improved (P < 0.001). Meanwhile, FT3 was elevated compared to the baseline (from 4.51 ± 0.78 pmol/L to 4.68 ± 0.87 pmol/L, P < 0.05), and reverse triiodothyronine (r‐T3) decreased from 1.03 ± 0.24 nmol/L to 0.92 ± 0.25 nmol/L (P < 0.001). Thyroid‐stimulating hormone significantly decreased as well (P < 0.001). Conclusions Decreased free thyroid hormone levels in normal range were associated with high glucose and insulin resistance. After MMC management, improvement of blood glucose and insulin resistance were accompanied by the restoration of low‐normal thyroid function.
ObjectiveIncreasing evidence suggests that osteocalcin (OC), a marker of bone formation, plays an important role in glucose homoeostasis. Few studies have investigated the relationship between OC levels in gestational diabetes mellitus (GDM) patients and their postpartum glucose metabolism. This study evaluated the relationship between OC levels in late pregnancy, their longitudinal changes, and postpartum glucose metabolism among GDM patients.MeasuresSerum OC was measured in late pregnancy and the postpartum period for 721 GDM patients. All patients underwent a 75-g oral glucose tolerance test (OGTT) at 6–8 weeks postpartum. According to postpartum OGTT outcomes, patients were categorized into abnormal glucose metabolism (AGM) (n=255) and normal glucose tolerance (NGT) groups (n=466). Glucose metabolism-related indices were measured and calculated. Logistic regression analysis and linear mixed-effects model were used to assess the association between OC and postpartum AGM.ResultsIn late pregnancy, OC levels were lower in the AGM group than in the NGT group (13.93 ± 6.90 vs 15.33 ± 7.63 ng/ml, P=0.015). After delivery, OC levels increased in both groups. However, OC levels remained lower in the AGM group than in the NGT group (23.48 ± 7.84 vs 25.65 ± 8.37 ng/ml, P=0.001). Higher OC levels in late pregnancy were associated with decreased risk of progressing to postpartum AGM (OR:0.96, 95%CI:0.94–0.99). Linear mixed-effects analysis showed that postpartum AGM patients exhibited consistently lower OC levels than NGT group from late pregnancy to the postpartum period after adjustment for cofactors (β=-1.70, 95% CI: -2.78– -0.62). ConclusionsIn GDM patients, consistently low levels of OC from late pregnancy to postpartum were associated with increased postpartum AGM risk. The increase in serum OC may act as a protective factor to curb the progression of AGM at postpartum for GDM patients.
Context Although diabetic peripheral neuropathy (DPN) is predominantly considered a disorder of the peripheral nerves, some evidence for central nervous system involvement has recently emerged. However, whether or to what extent the microstructure of central somatosensory tracts may be injured remains unknown. Objective To detect the microstructure of central somatosensory tracts in type 2 diabetic patients and to correlate it with the severity of DPN. Design Case-control study. Setting Tertiary referral hospital. Participants Fifty-seven subjects with type 2 diabetes (25 with DPN, 32 without DPN) and thirty-three nondiabetic controls. Intervention None. Main Outcome Measures The fractional anisotropy (FA) values of two major somatosensory tracts (the spinothalamic tract and its thalamocortical [spino-thalamo-cortical, STC] pathway, the medial lemniscus and its thalamocortical [medial lemnisco-thalamo-cortical, MLTC] pathway) were assessed based on diffusion tensor tractography. Regression models were further applied to detect the association of FA values with the severity of DPN in diabetic patients. Results The mean FA values of left STC and left MLTC pathways were significantly lower in patients with DPN than those without DPN and controls. Moreover, FA values of left STC and left MLTC pathways were significantly associated with the severity of DPN (expressed as Toronto Clinical Scoring System values) in patients after adjusting for multiple confounders. Conclusions Our findings demonstrated the axonal degeneration of central somatosensory tracts in type 2 diabetic patients with DPN. The parallel disease progression of the intra- and extracranial somatosensory system merits further attention to the central nerves in diabetic patients with DPN.
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