Associations of Thyroid Hormone Levels and Macrovascular Complications in Euthyroid Type 2 Diabetic Patients

Figures & data

Table 1 Demographical and Clinical Characteristics of the Study Population with and without Macrovascular Complications

Patients Not Stratified by BMI
Characteristics	Total (n=311)	Non-Macrovascular Complications (n=131)			Macrovascular Complications (n=180)	P value
Age (years)	56 (12)	54 (15)			58 (13)	<0.01
Sex (male/female)	180/131	81/50			99/81	0.228
Duration of T2DM (years)	8.00 (12.00)	6.00 (10.00)			10.00 (12.00)	0.001
SBP (mmHg)	130 (30)	130 (20)			138 (30)	0.043
DBP (mmHg)	80 (12)	80 (12)			80 (10)	0.347
BMI (Kg/mm^2)	26.51 ± 3.98	26.06 ± 3.99			26.85 ± 3.96	0.085
TSH (mIU/L)	1.83 (0.66)	1.89 (0.88)			1.79 (0.68)	0.254
FT3 (pmol/L)	4.42 (0.94)	4.58 (0.83)			4.30 (0.99)	0.002
FT4 (pmol/L)	12.53 (4.20)	13.47 (3.12)			12.27 (5.49)	0.001
HbA1c (%)	8.90 (3.10)	9.16 (3.00)			8.70 (2.70)	0.009
TG (mmol/L)	1.89 (1.50)	2.25 (1.46)			1.70 (1.53)	0.055
TC (mmol/L)	5.08 (1.35)	5.08 (1.02)			5.08 (1.56)	0.435
HDL-C (mmol/L)	1.17 (0.31)	1.13 (0.33)			1.17 (0.30)	0.025
LDL-C (mmol/L)	3.26 (1.00)	3.26 (0.83)			3.24 (1.19)	0.244
VLDL-C (mmol/L)	0.63 (0.34)	0.66 (0.32)			0.60 (0.34)	0.072
Insulin therapy (yes/no)	217/94	91/40			126/54	0.919
Patients with BMI<25 Kg/mm^2
Characteristics	Total (n=81)		Non-Macrovascular Complications (n=42)	Macrovascular Complications (n=39)		P value
Age (years)	55.95 ± 10.32		51.48 ± 10.85	60.77 ± 7.16		<0.01
Sex (male/female)	45/36		25/17	20/19		0.456
Duration of T2DM (years)	6.00 (11.00)		5.00 (9.50)	9.00 (13.00)		0.131
SBP (mmHg)	130 (24)		122.50 (21)	130 (30)		0.069
DBP (mmHg)	80 (11)		80 (13)	80 (10)		0.528
BMI (Kg/mm^2)	21.68 ± 1.77		21.68 ± 1.81	21.68 ± 1.76		0.997
TSH (mIU/L)	1.93 (0.77)		1.91 (0.88)	1.93 (0.76)		0.510
FT3 (pmol/L)	4.42 ± 0.70		4.56 ± 0.64	4.27 ± 0.75		0.059
FT4 (pmol/L)	12.75 (3.85)		13.85 (3.27)	12.27 (5.20)		0.030
HbA1c (%)	9.16 (4.00)		9.16 (4.02)	9.40 (4.00)		0.493
TG (mmol/L)	1.51 (1.51)		1.54 (1.49)	1.50 (1.34)		0.653
TC (mmol/L)	5.07 (1.18)		5.08 (0.71)	4.97 (1.78)		0.613
HDL-C (mmol/L)	1.20 (0.40)		1.20 ± 0.25	1.27 ± 0.30		0.258
LDL-C (mmol/L)	3.26 (1.13)		3.26 (0.72)	3.25 (1.29)		0.577
VLDL-C (mmol/L)	0.55 (0.29)		0.56 (0.27)	0.50 (0.31)		0.519
Insulin therapy (yes/no)	56/25		27/15	29/10		0.327
Patients with BMI≥25 Kg/mm ^2
Characteristics	Total (n=230)	Non-Macrovascular Complications (n=89)		Macrovascular Complications (n=141)		P value
Age (years)	56 (12)	54 (16)		58 (12)		0.001
Sex (male/female)	135/95	56/33		79/62		0.301
Duration of T2DM (years)	10.00 (12.00)	7.00 (10.50)		10.00 (12.00)		0.006
SBP (mmHg)	135.5 (26)	130 (20)		140 (28)		0.356
DBP (mmHg)	80 (10)	80 (10)		80 (10)		0.725
BMI (Kg/mm^2)	27.58 (3.70)	27.56 (3.73)		27.60 (3.59)		0.704
TSH (mIU/L)	1.82 (0.64)	1.89 (0.95)		1.76 (0.65)		0.315
FT3 (pmol/L)	4.45 (0.94)	4.58 (0.81)		4.30 (0.93)		0.011
FT4 (pmol/L)	12.37 (4.25)	13.31 (3.09)		12.27 (5.59)		0.006
HbA1c (%)	8.70 (2.70)	9.16 (2.50)		8.50 (2.70)		0.001
TG (mmol/L)	2.10 (1.66)	2.39 (1.60)		1.76 (1.66)		0.012
TC (mmol/L)	5.08 (1.43)	5.08 (1.11)		5.08 (1.61)		0.490
HDL-C (mmol/L)	1.15 (0.30)	1.10 (0.32)		1.17 (0.30)		0.017
LDL-C (mmol/L)	3.25 (1.00)	3.26 (0.89)		3.23 (1.14)		0.256
VLDL-C (mmol/L)	0.66 (0.34)	0.66 (0.27)		0.61 (0.37)		0.043
Insulin therapy (yes/no)	161/69	64/25		97/44		0.616

Note: Data are expressed as mean (SD), median (Interquartile range, IQR), or count (percentage) depending on the variable type.

Abbreviations: BMI, body mass index; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; VLDL-C, very low-density lipoprotein cholesterol; HbA1c, glycosylated hemoglobin; FT3, free triiodothyronine; FT4, free thyroxine (FT4); TSH, thyroid-stimulating hormone; SBP, systolic blood pressure; DBP, diastolic blood pressure; DM, diabetes mellitus.

Table 2 Prevalence Ratio of Macrovascular Complications Based on Multivariate Logistic Regression on Thyroid Hormone Levels

Thyroid Status	Model 1		Model 2
	OR (95% CI)	P value	OR (95% CI)	P value
Patients not stratified by BMI
TSH	0.835 (0.632–1.103)	0.205	0.816 (0.608–1.094)	0.174
FT3	0.589 (0.407–0.854)	0.005	0.534 (0.358–0.796)	0.002
FT4	0.854 (0.773–0.944)	0.002	0.844 (0.760–0.937)	0.001
Patients with BMI<25 Kg/m2
TSH	0.741 (0.386–1.424)	0.369	0.677 (0.301–1.524)	0.347
FT3	0.485 (0.218–1.083)	0.078	0.497 (0.202–1.221)	0.127
FT4	0.850 (0.688–1.049)	0.131	0.793 (0.614–1.024)	0.075
Patients with BMI≥25 Kg/m^2
TSH	0.824 (0.601–1.124)	0.222	0.816 (0.589–1.129)	0.219
FT3	0.601 (0.390–0.926)	0.021	0.568 (0.358–0.901)	0.016
FT4	0.862 (0.768–0.967)	0.012	0.853 (0.754–0.964)	0.011

Notes: Model 1: adjusted for age and sex. Model 2: adjusted for age, sex, duration of T2DM, SBP, DBP, BMI, HbA1c, TG, TC, HDL-C, LDL-C, and VLDL-C.

Abbreviations: OR, odds ratio; 95% CI, 95% confidence interval.

Figure 1 Prevalence ratio of macrovascular complications based on multivariate logistic regression on thyroid hormone levels. ((A) Adjusted for age and sex. (B) Adjusted for age, sex, duration of T2DM, SBP, DBP, BMI, HbA1c, TG, TC, HDL-C, LDL-C, and VLDL-C.).

Table 3 Prevalence Ratio of Macrovascular Complications Based on Multivariate Logistic Regression on Thyroid Hormone Levels Within Patients with Abnormal HbA1cHbA1c

Thyroid Status	Model 1		Model 2
	OR (95% CI)	P value	OR (95% CI)	P value
Patients not stratified by BMI
TSH	0.889 (0.666–1.188)	0.428	0.880 (0.649–1.192)	0.408
FT3	0.616 (0.420–0.904)	0.013	0.546 (0.358–0.828)	0.004
FT4	0.839 (0.755–0.933)	0.001	0.823 (0.760–0.920)	0.001
Patients with BMI<25 Kg/mm^2
TSH	0.854 (0.409–1.784)	0.674	0.776 (0.313–1.927)	0.585
FT3	0.524 (0.226–1.215)	0.132	0.519 (0.199–1.350)	0.178
FT4	0.850 (0.683–1.057)	0.144	0.800 (0.619–1.034)	0.088
Patients with BMI≥25 Kg/mm^2
TSH	0.857 (0.623–1.179)	0.342	0.846 (0.606–1.181)	0.325
FT3	0.627 (0.402–0.978)	0.040	0.582 (0.360–0.940)	0.027
FT4	0.845 (0.748–0.956)	0.007	0.829 (0.727–0.945)	0.005

Notes: Model 1: adjusted for age and sex. Model 2: adjusted for age, sex, duration of T2DM, SBP, DBP, BMI, HbA1c, TG, TC, HDL-C, LDL-C, and VLDL-C.

Abbreviations: OR, odds ratio; 95% CI, 95% confidence interval.

Figure 2 Prevalence ratio of macrovascular complications based on multivariate logistic regression on thyroid hormone levels within patients with abnormal HbA1c. ((A) Adjusted for age and sex. (B) Adjusted for age, sex, duration of T2DM, SBP, DBP, BMI, HbA1c, TG, TC, HDL-C, LDL-C, and VLDL-C.).