Ötiroid Tip 2 Diyabeti Olan Hastalarda HbA1c ve TSH Düzeylerinin Trigliserid Düzeylerine Etkisi

Yıl 2018, Cilt: 2 Sayı: 3, 113 - 118, 28.12.2018

Meral Mert , Yasemin Şefika Akdeniz Hamide Pişkinpaşa Özlem Sevgillioğlu Polat , Göktürk Öğredici İşıl Tevetoğlu Ayşe Esen Evin Bozkur Sema Çiftçi Doğanşen Yıldız Okuturlar

Öz

 

 Özet

Giriş
ve Amaç: Diyabet tüm dünyada ve ülkemizde sıklığı giderek
artan bir hastalıktır. Tip 2 Diyabetli hastalarda dislipidemi, koroner arter hastalığının
(KAH) gelişiminde önemli yere sahiptir.  Hba1c değeri yüksek olan kötü glisemik
kontrollü diyabetik hastalarda komplikasyon riski artmış olup dislipidemi
taraması ve tedavisi önemlidir. Normal tiroid fonksiyonlarındaki varyasyonların
dislipidemi ve  kardiyovasküler risk
üzerine etkisi net bilinmemektedir . Çalışmamızda
ötiroid Tip 2 diyabetes mellitus hastalarında trigliserid (TG) düzeyleri ile
HbA1c ve TSH ilişkisini araştırdık.

Yöntem:
19119  diyabet hastasının verileri retrospektif
olarak taranarak incelendi. 4908 hasta verileri çalışmaya alınmaya uygun
bulundu. HbA1c, TSH, glukoz ve trigliserid (TG) değerleri  kaydedildi. TG değerlerine göre 4 gruba
ayrılan hastalarda HbA1c ve TSH değerlerinin TG düzeyleri ile  ilişkisi araştırılıdı.

Bulgular: HbA1c ve trigliserid düzeyleri
arasında pozitif korelasyon, TSH ile negatif korelasyon saptandı.

Sonuç:
Özellikle Tip 2 diyabet hastalarında tiroid fonksiyon testleri
değerlendirilirken ötiroid olsalar dahi, glisemik regülasyon göstergelerinden
A1c düzeyleri ile TSH düzeyleri arasındaki ilişki ve TG düzeylerine etkileri
göz önüne alınmalı, A1c değerleri düştükten sonraki seyirleri kontrol edilerek,
tedavi ve takip yaklaşımları saptanmalıdır.

Anahtar
kelimeler:  Tip
2 Diyabetes Mellitus, Trigliserid, TSH, A1c

Summary

HbA1c, TSH and TG
relationship in type 2 diabetes

 

Introduction:
The prevalence of diabetes is increasing in our country and all over the world.
Dyslipidemia has an important role in the development of coronary artery
disease (CAD) in type 2 diabetic patients.  The risk of complications is increased in
diabetic patients with poor glycemic control and high Hba1c levels.  Therefore dyslipidemia screening and
treatment is important. The effect of variations in normal thyroid function on
dyslipidemia and cardiovascular risk is not clear.
So in this study, we investigated the assosiation between HbA1c, TSH and triglyceride
(TG) levels in euthyroid type 2 diabetic patients.

Methods:
The data of 19119 diabetic patients were retrospectively analyzed. 4908 patients’
data were eligible to be included in the study. HbA1c, TSH, glucose and
triglyceride (TG) values were recorded. Patients divided into 4 groups due to
TG levels in order to investigate assosiation between hba1c, tsh levels and
triglyceride levels in euthyroid, type 2 diabetic patients.

Results:
There was a positive correlation between triglyceride and HbA1c levels and
negative correlation between triglyceride and TSH levels.

Conclusion:
Especially when evaluating thyroid function tests in Type 2 diabetic patients
(even if they are euthyroid), the relationship between A1c levels (glycemic
control indicator) and TSH levels and their effects on TG levels should be
considered. Treatment and follow-up approaches should be determined after A1c
values are normalized.

Key
Word: Type 2 diabetes Mellitus, tryglyceride, TSH, A1c 

Anahtar Kelimeler

Tip 2 Diyabetes Mellitus, Trigliserid, TSH

Kaynakça

• KAYNAKLAR 1. Satman I, Omer B et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-80. 2. American Diabetes Association. Dyslipidemia Management in Adults With Diabetes. Diabetes Care 2004; 27: 68-71. 3. Goldberg IJ. Lipoprotein lipase and lipolysis: central roles in lipoprotein metabolism and atherogenesis. J Lipid Res 1996; 37: 693-707. 4. Tavangar K, Murata Y et al. Regulation of lipoprotein lipase in the diabetic rat. J Clin Invest 1992; 90: 1672-1678 5. Türkiye Endokrinoloji ve Metabolizma Derneği Dislipidemi Tanı ve Tedavi Kılavuzu 2018; 85-86 6. Rosenson RS, Davidson MH et al.Genetics and Causality of Triglyceride-Rich Lipoproteins in Atherosclerotic Cardiovascular Disease. JAC. 2014;64(23):2525-2540. 7. Windler E. What is the consequence of an abnormal lipid profile in patients with type 2 diabetes or the metabolic syndrome? Atheroscler Suppl 2005;6: 11-14. 8. Duntas LH. Thyroid disease and lipids. Thyroid 2002 ;12: 287–293. 9. 9.Canaris GJ, Manowitz NR et al The Colorado thyroid disease prevalence study. Archives of Internal Medicine 2000 ;160: 526–534. 10. 10.Surks MI, Ortiz E et al.Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. Journal of the American Medical Association 2004 ;291: 228–238. 11. Iqbal A, Jorde R et al.Serum lipid levels in relation to serum thyroid-stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: the Tromso Study. Journal of Internal Medicine 2006; 260: 53–61. 12. Bakker SJ, ter Maaten JC et al.The relationship between thyrotropin and low density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects. Journal of Clinical Endocrinology and Metabolism 2001; 86: 1206–1211. 13. 13.Glycosylaed Haemoglobin, HbA1C. Erişim: hptt:// clinlabnavigator.com/test-interpretations/haemoglobin-a1c 14. Haffner SM, Lehto S et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339:229–234. 15. (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486–2497. 16. Khan HA, Sobki SH et al. Association between glycaemic control and serum lipids profile in type 2 diabetic patients: HbA1c predicts dyslipidaemia. Clin Exp Med 2007; 7: 24-9. 17. Mahato RV, Gyawali P ,et al. Association between glycaemic control and serum lipid profile in type 2 diabetic patients: glycated haemoglobin as a dual biomarker. Biomed Res 2011; 22: 375-80. 18. Ebru Özdoğan, Osman Özdoğan et al. Tip 2 Diyabet Hastalarında Kan Lipid Düzeylerinin Hba1c ve Obezite ile İlişkisi şişli etfal hastanesi tıp bülteni 2015 ;49 ;4:248-254 19. Selvin E, Wattanakit K et al.HbA1c and peripheral arterial disease in diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 2006; 29:877-882 20. Johnson JL. Diabetes control in thyroid disease. Diabetes Spectr. 2006;19:148–153. 21. Granner DK. Thyroid hormones. In: Murray RK, Granner DK, Mayes PA, Rodwell VW, editors. Harper’s Biochemistry. 25. London: Prentice-Hall International Inc.; 2000. pp. 533–538. 22. Kim MK, Kwon HS, et al. Effects of thyroid hormone on A1C and glycated albumin levels in nondiabetic subjects with overt hypothyroidism. Diabetes Care. 2010;33:2546–8