Glycemic variation in uncontrolled Graves’ disease patients with normal glucose metabolism: Assessment by continuous glucose monitoring

Abstract

Purpose To observe the glycemic variation (GV) in uncontrolled Graves’ disease (GD) patients with normal glucose metabolism measured by continuous glucose monitoring (CGM). Methods This was a single-center, open-label, observational study. From January 2017 to October 2017, 20 GD patients with normal glucose metabolism and 24 healthy control subjects were recruited. Serum samples were obtained at 0, 30, and 120 min after oral glucose loading for glucose, insulin, and C-peptide level measurements. Fasting plasma fasting free triiodothyronine (FT3), free thyroxin (FT4), and thyroid stimulating hormone concentrations were also detected. All participants were subjected to a 3-day CGM after baseline data were collected. The primary endpoint was the difference in the mean amplitude of the glycemic excursions between the two groups. Results Compared with the healthy subjects, the GD patients had higher mean amplitude of glycemic excursions (MAGE) ( P < 0.01). Multiple linear stepwise regression analysis showed that FT4 level was an independent factor for the MAGE. Interestingly, the GD patients had a significant prolongation in the time to peak glucose, especially after breakfast ( P < 0.01), and the elevation in the incremental area under the curve of glucose after breakfast till 4 hours later. Conclusions Uncontrolled GD patients with normal glucose metabolism had a greater GV, and the FT4 level may contributed to the increased GV.

DES-Tcell is a knowledgebase for exploring immunology-related literature

“…CCL5-CCR5 signaling induces cellular metabolic activity by increasing the expression of glucose transporter 1 (Glut1), glucose uptake (mTOR-dependent), and intracellular ATP levels 102 , 103 . Increased levels of serum CCL5 have been observed in GD patients as well as impaired glucose tolerance (IGT), insulin resistance (IR) and insulin secretion 100 , 104 , 105 .…”

Changes in Glucose Intolerance after Treatment with Antithyroid Drugs in Patients with Graves' Disease Using Continuous Glucose Monitoring: A Pilot Study

“…Using CGM, we reported previously that the use of potassium iodide for the treatment of a GD patient with complications of thyroid crisis and type 2 diabetes resulted in improvement of the mean glucose levels and glucose variability ( 10 ). The use of CGM in another study identified higher values of mean glucose and glucose variability (MAGE, SD, CV) in 20 patients with untreated GD than in healthy participants ( 11 ). In the same study, the fT4 correlated significantly with the mean glucose and glucose variability in patients with GD, and a multivariate analysis identified fT4 as the thyroid function parameter most significantly related to MAGE ( 11 ).…”

“…The use of CGM in another study identified higher values of mean glucose and glucose variability (MAGE, SD, CV) in 20 patients with untreated GD than in healthy participants ( 11 ). In the same study, the fT4 correlated significantly with the mean glucose and glucose variability in patients with GD, and a multivariate analysis identified fT4 as the thyroid function parameter most significantly related to MAGE ( 11 ). In the present study, we believe that fT4 and CGM-related parameters showed no significant correlation because of the very small number of cases and the fact that fT4 could not be measured properly because of its high value of >7.77 ng/mL in 5 of the 15 cases.…”

Cardiovascular risk factors, autoimmunity and insulin resistance in Graves' disease

“…36,37 Também o aumento da gliconeogénese e da absorção intestinal de glicose, estimulados pelas hormonas tiroideias, contribuem para estas alterações. 15,16,38 No nosso estudo verificou-se uma correlação positiva entre o VT e a HbA1c no subgrupo em remissão, o que se pode justificar pelos efeitos tróficos causados pelas alterações do metabolismo glicémico na glândula tiroideia. 39,40 Alternativamente, esta correlação poderá estar relacionada com uma autoimunidade mais pronunciada nos doentes com maior volume tiroideu, o que poderá estar associado a um maior impacto adverso no metabolismo da glicose.…”

“…5,8,9 O excesso de hormonas tiroideias afeta vários órgãos, interferindo com a atividade do sistema nervoso simpático, 4 aumentando a termogénese tecidual e a taxa metabólica basal e reduzindo a tolerância à glicose, alterando os níveis séricos de colesterol e a resistência vascular sistémica, [10][11][12][13] resultando num aumento do risco e mortalidade cardiovascular. [14][15][16] O hipertiroidismo não tratado poderá resultar em perda de peso, osteoporose, fraturas, fibrilhação auricular, eventos embólicos e disfunção cardiovascular. 5 Os fatores ambientais como a exposição ao iodo ou ao tabaco, infeções e stresse estão frequentemente implicados na patogénese da DG.…”