Sight-Threatening Thyroid Eye Disease: Role of Diabetes Mellitus and Interaction with Other Risk Factors

Abstract

Purpose: The aim of the study was to investigate whether diabetes mellitus (DM) is an independent risk factor in sight-threatening thyroid eye disease (ST-TED) and explore the interaction of DM with other known risk factors in TED. Methods: This was a retrospective cohort study and included 202 consecutive TED patients presenting between 2013 and 2019. Data collected included demography, history of smoking, thyroid dysmetabolism, and presence of DM, TED-duration, activity and severity, best-corrected visual acuity (BCVA), and follow-up. Primary outcome measure was development of ST-TED and secondary outcome measures included change in BCVA, activity, and bilateral ST-TED. Results: Mean age of the cohort was 52.14 + 9.14 years and 74 (36%) were male. DM was present in 49 (24%) and a positive history of smoking in 65 (32%) TED patients. Cox’s proportional hazards showed the presence of DM (hazard ratio [HR] 2.22; P = 0.02) and a positive history of smoking (HR 3.62; P = 0.003) were significant risk factors for development of ST-TED and dysthyroid optic neuropathy (DON). Older age was a risk factor (HR 1.05; P = 0.02) for DON. DM increased the risk of developing bilateral ST-TED (OR 4.14; P = 0.004). Median follow-up was 4 months (range 0.1–96 months). A linear mixed model to predict longitudinal interaction between risk factors, found TED patients in DM group were likely to have worsening of visual function and a positive history of smoking accentuated this adverse outcome. Conclusion: DM and smoking are major independent risk factors predictive of ST-TED. Coexisting DM either singularly or in combination with smoking may predict worsening of visual function in TED patients.

HbA1c: an independent risk factor for dysthyroid optic neuropathy

“…In this study, we present data on the serum levels of selected diabetes-related indicators and their changes associated with TAO and DON. Previous studies have shown that DM is a risk factor for TAO (27,28,42). The prevalence of T1DM in patients with TAO is higher than that in ordinary people (42).…”

“…The basal plasma glucose concentration in patients with Graves' disease was signi cantly higher than that in normal subjects(26). DM and smoking are major independent risk factors predictive of DON (27). T2DM with Graves' disease has more frequent and severe TAO(28, 29).…”

“…Although several studies (27)(28)(29)42) have reported an association between TAO and DM, the speci c DM indicators that can be used as early biomarkers of DON remain unclear. The aim of this study was to investigate the frequencies of islet β-cell autoantibodies and IR in TAO in order to characterize the speci c features of this group of endocrine patients and nd risk factors for DON.…”

Thyroid Eye Disease and Its Association With Diabetes Mellitus: A Major Review

“…In this series, sight-threatening TED was more common in the presence of DM (42% vs. 13%). 9 Furthermore, the DM group was found to have bilateral (25% vs. 5%) and recurrent sight-threatening disease (8% vs. 1.2%), thus accentuating the risk. 9 This series reported DM and smoking doubled the risk of developing DON within the first year after the onset of TED.…”

“…The presence of DM in 15.1%–53.2% of the TED patients is notable in these studies. 3,8–10,22,23 The reported prevalence of DM (including T1DM and T2DM) is 8.5% worldwide, 8% in North America, and 7% in India. 24–26…”