Association of thyroid stimulating hormone and time in range with risk of diabetic retinopathy in euthyroid type 2 diabetes.

AIMS: Diabetic retinopathy (DR) can occur even in well-controlled type 2 diabetes, suggesting residual risks of DR in this population. In particular, we investigated the combined effect of thyroid function and glycemic control assessed by an emerging metric, time in range (TIR), with DR.

MATERIALS AND METHODS: In this cross-sectional study, a total of 2,740 euthyroid patients with type 2 diabetes were included. Thyroid indicators, including thyroid stimulating hormone (TSH), free triiodothyronine, free thyroxine, thyroid peroxidase antibody and thyroglobulin antibody, were measured. TIR was measured with continuous glucose monitoring (CGM) data.

RESULTS: Overall, the multivariable-adjusted odds ratios (ORs) for DR across ascending tertiles of TSH were 1.00 (reference), 1.05 (95% confidence interval [CI] 0.84-1.30), and 1.47 (95% CI 1.18-1.83). Even in well-controlled participants who achieved a TIR target of > 70% (n = 1449), the prevalence of DR was 23.8%, which was significantly related to TSH (OR = 1.54, 95% CI 1.12-2.12, highest vs. lowest TSH tertile). Participants were then classified into 6 groups by the joint categories of TIR (> 70%, ≤ 70%) and TSH (tertiles), and the multivariable-adjusted ORs for DR were highest in the TIR ≤ 70% and the highest TSH tertile group (OR = 1.96, 95% CI 1.41-2.71) when compared with the TIR > 70% and the lowest TSH tertile group.

CONCLUSIONS: In type 2 diabetes patients with well-controlled glycemic status, higher TSH within the normal range was associated with increased risk of DR. The combination of suboptimal TSH and TIR further increased the risk for DR. This article is protected by copyright. All rights reserved.