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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 16 NUMBER 2 • NOVEMBER 2019
55
with and without hypothyroidism. It was done in a single-physician
practice in South Africa in a predominantly white population, and
results must be interpreted in this context.
The major findings of the study were the following: hypothyroid
subjects were significantly more likely to be female, older, with a
longer duration of diabetes and less likely to be black; diabetic
control, defined by HbA
1c
level, was better in hypothyroid subjects
than in the controls despite less use of hypoglycaemic agents;
hypothyroid subjects had higher HDL cholesterol and lower
triglyceride levels; lower eGFR and greater prevalence of CKD; there
was a trend to increased DR with no differences in amputations or
DPN; and a trend to increased CV events. However after adjustment
for baseline differences, the association of hypothyroidism with
DKD and DR was no longer apparent using multivariate analysis.
However the trend for CVD remained.
Table 4.
Associations between DKD and patient characteristics on uni-
and multivariate analysis
Univariate
Multivariate
Variable
OR (95% CI)
p
-value OR (95% CI)
p
-value
Age, 5-year increase 1.57 (1.37–1.79) < 0.001 1.63 (1.39–1.91) < 0.001
Gender, female
1.05 (0.64–1.72) 0.854 0.77 (0.43–1.38) 0.382
Race, non-black
1.16 (0.58–2.33) 0.668 0.67 (0.30–1.48) 0.322
Hypothyroid
1.74 (1.06–2.88) 0.029 1.25 (0.68–2.29) 0.467
HBA
1c
0.91 (0.32–2.58) 0.854 2.07 (0.60–7.19) 0.250
Duration of T2DM
1.60 (1.14–2.24) 0.007 0.90 (0.60–1.33) 0.592
Table 5.
Associations between DPN and patient characteristics on uni-
and multivariate analysis
Univariate
Multivariate
Variable
OR (95% CI)
p
-value OR (95% CI)
p
-value
Age, 5-year increase 1.21 (1.10–1.34) < 0.001 1.19 (1.05–1.35) 0.008
Gender, female
1.10 (0.70–1.71) 0.698 1.07 (0.65–1.77) 0.789
Race, non-black
2.11 (1.11–4.02) 0.023 1.66 (0.83–3.31) 0.152
Hypothyroid
0.92 (0.59–1.43) 0.706 0.63 (0.37–1.08) 0.094
CKD present
1.76 (1.06–2.90) 0.028 1.22 (0.70–2.16) 0.486
HBA
1c
1.37 (0.54–3.52) 0.507 1.47 (0.51–4.23) 0.480
Duration of DM
1.63 (1.21–2.20) 0.001 1.37 (0.97–1.93) 0.075
Table 6.
Associations between DR and patient characteristics on uni-
and multivariate analysis
Univariate
Multivariate
(
n
= 75)
(
n
= 75)
Variable
OR (95% CI)
p
-value OR (95% CI)
p
-value
Age, 5-year increase 1.26 (1.02–1.54) 0.029 1.19 (0.89–1.60) 0.235
Hypothyroid
2.2 (0.86–5.65) 0.102 1.61 (0.55–4.68) 0.386
CKD present
1.59 (0.62–4.06) 0.334 0.89 (0.29–2.75) 0.838
HBA
1c
5.67 (0.64–50.13) 0.118 6.52 (0.56–75.22) 0.133
Duration of DM
1.98 (0.97–4.07) 0.061 1.24 (0.52–2.99) 0.624
Table 7.
Associations between CVD and patient characteristics on uni-
and multivariate analysis
Univariate
Multivariate
(
n
= 75)
(
n
= 75)
Variable
OR (95% CI)
p
-value OR (95% CI)
p
-value
Age, 5-year increase 1.35 (1.18–1.56) < 0.001 1.41 (1.17–1.70) < 0.001
Gender, female
0.25 (0.13–0.48) < 0.001 0.16 (0.07–0.36) < 0.001
Race, non-black
1.10 (0.48–2.49) 0.826 0.63 (0.24–1.62) 0.336
Obese
0.74 (0.39–1.42) 0.371 0.87 (0.41–1.84) 0.713
Hypothyroid
1.76 (0.97–3.19) 0.064 1.97 (0.94–4.13) 0.073
HBA
1c
0.90 (0.26–3.13) 0.872 1.48 (0.33–6.71) 0.613
HDL-C
0.43 (0.15–1.27) 0.127 0.63 (0.18–2.23) 0.472
Duration of T2DM
1.70 (1.11–2.60) 0.014 1.19 (0.71–2.01) 0.512
1 mmol/l,
p
= 0.001) and triglyceride levels were significantly lower
(1.9 vs 2.1 mmol/l,
p
= 0.034). There was no difference in low-
density lipoprotein (LDL) cholesterol, but all subjects received statin
therapy unless contra-indicated.
Microvascular complications tended to occur more frequently
in the hypothyroid group. The eGFR was significantly lower in the
cases (66 vs 75 ml/min,
p
= 0.001), but there was no difference
in urine ACR. On univariate analysis (Table 3), the odds ratio for
DKD was 1.74 (
p
= 0.029), DPN was 0.92 (
p
= 0.7) and DR was
2.2 (
p
= 0.1). Because of baseline differences between the groups,
a multivariate analysis was performed to adjust for confounders
(Tables 4–6). The differences between the groups were no
longer significant. The most important predictor of microvascular
complications was a five-year increase in age, especially for DKD
(OR 1.63,
p
< 0.001) and DPN (OR 1.19,
p
= 0.008).
There was a trend towards a higher incidence of CVD in the
hypothyroid group (OR 1.76, p = 0.06) that was still present in
the multivariate analysis (OR 1.97,
p
= 0.07) (Table 7). The most
important predictor of CVD was age, and female gender appeared
protective. Amputations due to diabetes were 3.1% in the controls
and 3.0% in the cases (
p
= 0.725)
Discussion
This was a cross-sectional, retrospective study comparing primarily
micro- and macrovascular complications in type 2 diabetes subjects
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