Tiroit hastalığı olanlarda trigliserit/glikoz indeksi insülin direnci belirteci olarak kullanılabilir mi?
Öz
Amaç: İnsülin direnci, tip 2 diyabete giden öncül yolağı oluşturur ve diyabet teşhis edilmeden çok önce mevcuttur. Trigliserit/glikoz (TyG) indeksi, son dönemlerde insülin direncinin taranmasında kullanılan basit, güvenilir, kolay ulaşılabilir, maliyet-etkin bir tarama yöntemidir. Çalışmamızın amacı TyG indeksinin, tiroit hastalığı olan kişilerde insülin direnci belirteci olarak kullanılıp kullanılamayacağını araştırmaktır. Gereç ve Yöntem: Çalışmamız retrospektif olarak, 15.04.2016-15.10.2017 arasında Obezite Polikliniğimize başvuran 1280 hastanın dosyası taranarak yapıldı. Açlık kan şekeri, trigliserit ve TSH düzeyi bakılmış ve TSH düzeyi 0,5-10 mU/ml olan hastalar dâhil edildi. Çalışmaya başlamadan önce Girişimsel Olmayan Etik Kurulu onayı alındı. Hastalarda insülin direncinin varlığı Homeostatic Model Assesment of Insulin Resistance (HOMA-IR) düzeyine göre belirlendi. HOMA-IR≥2,5 olan hastalarda insülin direncinin olduğu, HOMA-IR<2,5 olan hastalarda ise olmadığı kabul edildi. Değişkenler arası ilişkilerin değerlendirilmesinde Pearson korelasyon analizi ve Spearman korelasyon analizi kullanıldı. Trigliserit/glikoz indeksinin, insülin direnci öngörülebilirliğini ve kesim noktalarını belirleyebilmek için Receiver Operating Characteristic Curve (ROC) analizi kullanıldı. Anlamlılık p<0,05 olarak kabul edildi. Bulgular: Çalışma %85,3’ü (n=515) kadın, %14,7’si erkek toplam 604 bireyle yapıldı. Bireylerin %45’inde (n=272) insülin direnci, %18,4’ünde (n=111) tiroit hastalığı vardı. Çalışmaya alınan hastalardan HOMA-IR ≥2,5 olanların TSH değerlerinin diğer gruba göre daha yüksek olduğu gözlendi (p=0,001). Sadece tiroit hastalığı olanlar değerlendirilerek ROC analizi yapıldığında; TyG indeksinin, insülin direnci olan hastaların ayırımını yapamadığı saptandı. Elde edilen ROC eğrisinde altta kalan alanın %64,7, standart hatasının %2,4 olduğu belirlendi. Sonuç: Çalışmamızda tiroit hastalığı olan kişilerde TyG indeksinin insülin direnci belirteci olarak kullanılamayacağı ortaya çıkmıştır.
Anahtar Kelimeler
Hipotiroidizm insülin direnci tiroit stimule edici hormon trigliseritler glikoz
Kaynakça
- Havekes B, Sauerwein HP. Adipocyte-myocyte crosstalk in skeletal muscle insulin resistance; is there a role for thyroid hormone? Curr Opin Clin Nutr Metab Care. 2010; 13 (6): 641-6.
- Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J of Epidemiol 2013; 28 (2): 169-80.
- Lee S-H, Kwon H-S, Park Y-M, Ha H-S, Jeong SH, Yang HK, et al. Predicting the development of diabetes using the product of triglycerides and glucose: the Chungju Metabolic Disease Cohort (CMC) study. PLoS One. 2014; 9 (2): e90430.
- DeFronzo RA. From the triumvirate to the „ominous octet”: a new paradigm for the treatment of type 2 diabetes mellitus. Clinical Diabetology. 2009; 10 (3): 101-28.
- Warram JH, Martin BC, Krolewski AS, Soeldner JS, Kahn CR. Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents. Ann Intern Med. 1990; 113 (12): 909-15.
- Zhang M, Wang B, Liu Y, Sun X, Luo X, Wang C, et al. Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: the rural Chinese cohort study. Cardiovasc Diabetol. 2017; 16 (1): 30.
- Ersin A, Faruk A, Betül A ve ark. Türkiye Endokrinoloji ve Metabolizma Derneği. Tiroit hastalıkları Tanı, Tedavi ve İzlem Kılavuzu. 1.Baskı. Ankara: Türkiye Klinikleri Basımevi;2009: s: 37. [cited 28.11.2019]. Available from: http://temd.org.tr/admin/uploads/tbl_kilavuz/20190426165340-2019tbl_kilavuze72e4ddf38.pdf
- Peppa M, Koliaki C, Nikolopoulos P, Raptis SA. Skeletal muscle insulin resistance in endocrine disease. BioMed Research International. 2010; v2010:15.
- Muscogiuri G, Sorice GP, Mezza T, Prioletta A, Lassandro AP, Pirronti T, et al. High-Normal TSH Values in Obesity: Is It Insulin Resistance or Adipose Tissue's Guilt? Obesity (Silver Spring). 2013; 21 (1): 101-6.
- Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol. 2009; 160 (5): 785-90.
- Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metabol. 2006; 91 (12): 4930-7.
- Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014; 13 (1): 146.
- Davies T, Marians R, Latif R. The TSH receptor reveals itself. Journal Clin Invest. 2002; 110 (2): 161-4.
- Guerrero-Romero, F., Simental-Mendía, L. E., González-Ortiz, M., Martínez-Abundis, E., Ramos-Zavala, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. The Journal of Clinical Endocrinology & Metabolism, 2010, 95 (7), 3347-3351.
- Simental-Mendía, L. E., Rodríguez-Morán, M., & Guerrero-Romero, F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metabolic syndrome and related disorders, 2008, 6 (4), 299-304.
- Peeters RP, van der Deure WM, van den Beld AW, van Toor H, Lamberts SW, Janssen JA, et al. The Asp727Glu polymorphism in the TSH receptor is associated with insulin resistance in healthy elderly men. Clin Endocrinol (Oxf). 2007; 66 (6): 808-15.
- Varim C, Kaya T, Varim P, Nalbant A, Vatan MB, Yaylaci S, et al. Insulin resistance in the patients with euthyroid Hashimoto thyroiditis. Biomedical Research. 2017; 28 (4): 1543-7.
- Knudsen N, Laurberg P, Rasmussen LB, Bülow I, Perr ld H, Ovesen L, et al. Small d fferences n thyro d function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metabol. 2005; 90 (7): 4019-24.
- Navarro-Gonzalez D, Sanchez-Inigo L, Pastrana-Delgado J, Fernandez-Montero A, Martinez JA. Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort. Prev Med. 2016; 86: 99-105.
- Facchini FS, Hollenbeck CB, Jeppesen J, Chen Y-DI, Reaven G. Insulin resistance and cigarette smoking. The Lancet. 1992; 339 (8802): 1128-30.
- Fernández-Real JM, Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev 2003; 24 (3): 278-301.
- Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. The Lancet. 2005; 365 (9468): 1415-28.
- Bakker SJ, ter Maaten JC, Popp-Snijders C, Slaets JP, Heine RJ, Gans RO. The relationship between thyrotropin and low-density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects. J Clin Endocrinol Metab. 2001; 86 (3): 1206-11.
- Kobayashi S, Maejima S, Ikeda T, Nagase M. Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis. Nephrology Dialysis Transplantation. 2000; 15 (1): 65-70.
- Rochon C, Tauveron I, Dejax C, Benoit P, Capitan P, Fabricio A, et al. Response of glucose disposal to hyperinsulinaemia in human hypothyroidism and hyperthyroidism. Clin Sci. 2003; 104 (1): 7-15.
- Stanická S, Vondra K, Pelikánová T, Vlček P, Hill M, Zamrazil V. Insulin sensitivity and counter-regulatory hormones in hypothyroidism and during thyroid hormone replacement therapy. Clin Chem Lab Med. 2005; 43 (7): 715-20.
- Fernández-Real J-M, L pez-Bermejo A, Castro A, Casamitjana R, Ricart W. Thyroid function is intrinsically linked to insulin sensitivity and endothelium-dependent vasodilation in healthy euthyroid subjects. J Clin Endocrin Metab. 2006; 91 (9): 3337-43.
- Zhu P, Liu X, Mao X. Thyroid-Stimulating Hormone Levels Are Positively Associated with Insulin Resistance. Med Sci Monit. 2018; 24: 342.
Can triglyceride/glucose index be used as a marker of insulin resistance in patients with thyroid disease?
Öz
Aim: Insulin resistance is the precursor pathway leading to type 2 diabetes and is present long before diabetes is diagnosed. The triglyceride-glucose index (TyG index) is a simple, reliable, cost-effective screening method that has recently been used for screening insulin resistance. The aim of our study is to evaluate whether TyG index can be used as insulin resistance marker in patients with thyroid disease. Materials and Methods: The registry files of 1280 patients applied to the obesity outpatient clinic between 15.04.2016-15.10.2017 were screened for this retrospective study. 604 patients of whom glucose, triglyceride and TSH levels were recorded in their files and TSH levels were 0.5-10 mU/ml were included in the study.
Approval was obtained from Noninvasive Ethics Committee before starting the study. The presence of insulin resistance was determined according to the level of the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). It was assumed that patients with HOMA-IR≥2.5 had insulin resistance. A Pearson and Spearman correlation analyze was used for the evaluation of the relationship between variables. ROC analysis was used to determine the predictability of TyG index to diagnose insulin resistance and cut-off points. P<0.05 was taken to indicate statistical significance. Results: The study was performed among 604 patients. 85.3% of the patients were women while 14.7% of them were men. 45% (n=272) of the individuals had insulin resistance, and 18.4% (n=111) of them had thyroid disease. It was detected that the TSH levels of the patients with insulin resistance was significantly higher (p=0,001). It was found that TyG index could not discriminate patients with insulin resistance. In the ROC curve obtained, the underlying area was 64.7% and standard error was 2.4%. Conclusions: In this study, it has emerged that the TyG index can’t be used as biomarker for detecting insulin resistance who has thyroid disease.
Anahtar Kelimeler
Hypothyroidism insulin resistance thyroid-stimulating hormone triglycerides glucose
Kaynakça
- Havekes B, Sauerwein HP. Adipocyte-myocyte crosstalk in skeletal muscle insulin resistance; is there a role for thyroid hormone? Curr Opin Clin Nutr Metab Care. 2010; 13 (6): 641-6.
- Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J of Epidemiol 2013; 28 (2): 169-80.
- Lee S-H, Kwon H-S, Park Y-M, Ha H-S, Jeong SH, Yang HK, et al. Predicting the development of diabetes using the product of triglycerides and glucose: the Chungju Metabolic Disease Cohort (CMC) study. PLoS One. 2014; 9 (2): e90430.
- DeFronzo RA. From the triumvirate to the „ominous octet”: a new paradigm for the treatment of type 2 diabetes mellitus. Clinical Diabetology. 2009; 10 (3): 101-28.
- Warram JH, Martin BC, Krolewski AS, Soeldner JS, Kahn CR. Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents. Ann Intern Med. 1990; 113 (12): 909-15.
- Zhang M, Wang B, Liu Y, Sun X, Luo X, Wang C, et al. Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: the rural Chinese cohort study. Cardiovasc Diabetol. 2017; 16 (1): 30.
- Ersin A, Faruk A, Betül A ve ark. Türkiye Endokrinoloji ve Metabolizma Derneği. Tiroit hastalıkları Tanı, Tedavi ve İzlem Kılavuzu. 1.Baskı. Ankara: Türkiye Klinikleri Basımevi;2009: s: 37. [cited 28.11.2019]. Available from: http://temd.org.tr/admin/uploads/tbl_kilavuz/20190426165340-2019tbl_kilavuze72e4ddf38.pdf
- Peppa M, Koliaki C, Nikolopoulos P, Raptis SA. Skeletal muscle insulin resistance in endocrine disease. BioMed Research International. 2010; v2010:15.
- Muscogiuri G, Sorice GP, Mezza T, Prioletta A, Lassandro AP, Pirronti T, et al. High-Normal TSH Values in Obesity: Is It Insulin Resistance or Adipose Tissue's Guilt? Obesity (Silver Spring). 2013; 21 (1): 101-6.
- Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol. 2009; 160 (5): 785-90.
- Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metabol. 2006; 91 (12): 4930-7.
- Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol. 2014; 13 (1): 146.
- Davies T, Marians R, Latif R. The TSH receptor reveals itself. Journal Clin Invest. 2002; 110 (2): 161-4.
- Guerrero-Romero, F., Simental-Mendía, L. E., González-Ortiz, M., Martínez-Abundis, E., Ramos-Zavala, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. The Journal of Clinical Endocrinology & Metabolism, 2010, 95 (7), 3347-3351.
- Simental-Mendía, L. E., Rodríguez-Morán, M., & Guerrero-Romero, F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metabolic syndrome and related disorders, 2008, 6 (4), 299-304.
- Peeters RP, van der Deure WM, van den Beld AW, van Toor H, Lamberts SW, Janssen JA, et al. The Asp727Glu polymorphism in the TSH receptor is associated with insulin resistance in healthy elderly men. Clin Endocrinol (Oxf). 2007; 66 (6): 808-15.
- Varim C, Kaya T, Varim P, Nalbant A, Vatan MB, Yaylaci S, et al. Insulin resistance in the patients with euthyroid Hashimoto thyroiditis. Biomedical Research. 2017; 28 (4): 1543-7.
- Knudsen N, Laurberg P, Rasmussen LB, Bülow I, Perr ld H, Ovesen L, et al. Small d fferences n thyro d function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metabol. 2005; 90 (7): 4019-24.
- Navarro-Gonzalez D, Sanchez-Inigo L, Pastrana-Delgado J, Fernandez-Montero A, Martinez JA. Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort. Prev Med. 2016; 86: 99-105.
- Facchini FS, Hollenbeck CB, Jeppesen J, Chen Y-DI, Reaven G. Insulin resistance and cigarette smoking. The Lancet. 1992; 339 (8802): 1128-30.
- Fernández-Real JM, Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev 2003; 24 (3): 278-301.
- Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. The Lancet. 2005; 365 (9468): 1415-28.
- Bakker SJ, ter Maaten JC, Popp-Snijders C, Slaets JP, Heine RJ, Gans RO. The relationship between thyrotropin and low-density lipoprotein cholesterol is modified by insulin sensitivity in healthy euthyroid subjects. J Clin Endocrinol Metab. 2001; 86 (3): 1206-11.
- Kobayashi S, Maejima S, Ikeda T, Nagase M. Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis. Nephrology Dialysis Transplantation. 2000; 15 (1): 65-70.
- Rochon C, Tauveron I, Dejax C, Benoit P, Capitan P, Fabricio A, et al. Response of glucose disposal to hyperinsulinaemia in human hypothyroidism and hyperthyroidism. Clin Sci. 2003; 104 (1): 7-15.
- Stanická S, Vondra K, Pelikánová T, Vlček P, Hill M, Zamrazil V. Insulin sensitivity and counter-regulatory hormones in hypothyroidism and during thyroid hormone replacement therapy. Clin Chem Lab Med. 2005; 43 (7): 715-20.
- Fernández-Real J-M, L pez-Bermejo A, Castro A, Casamitjana R, Ricart W. Thyroid function is intrinsically linked to insulin sensitivity and endothelium-dependent vasodilation in healthy euthyroid subjects. J Clin Endocrin Metab. 2006; 91 (9): 3337-43.
- Zhu P, Liu X, Mao X. Thyroid-Stimulating Hormone Levels Are Positively Associated with Insulin Resistance. Med Sci Monit. 2018; 24: 342.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2020 |
| Gönderilme Tarihi | 29 Ağustos 2019 |
| Yayımlandığı Sayı | Yıl 2020Cilt: 59 Sayı: 3 |
