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KMID : 1141520210360061277
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Endocrinology and Metabolism
2021 Volume.36 No. 6 p.1277 ~ p.1286
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Risk of Diabetes in Patients with Long-Standing Graves’ Disease: A Longitudinal Study
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Song E-Yun
Koo Min-Ji
Noh Eun-Jin
Hwang Soon-Young
Park Min-Jeong
Kim Jung-A
Roh Eun
Choi Kyung-Mook
Baik Sei-Hyun
Cho Geum-Joon
Yoo Hye-Jin
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Abstract
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Background: The detrimental effects of excessive thyroid hormone on glucose metabolism have been widely investigated. However, the risk of diabetes in patients with long-standing hyperthyroidism, especially according to treatment modality, remains uncertain, with few longitudinal studies.
Methods: The risk of diabetes in patients with Graves’ disease treated with antithyroid drugs (ATDs) for longer than the conventional duration (≥2 years) was compared with that in age-and sex-matched controls. The risk was further compared according to subsequent treatment modalities after a 24-month course of ATD: continuation of ATD (ATD group) vs. radioactive iodine ablation (RIA) group.
Results: A total of 4,593 patients were included. Diabetes was diagnosed in 751 (16.3%) patients over a follow-up of 7.3 years. The hazard ratio (HR) for diabetes, after adjusting for various known risk factors, was 1.18 (95% confidence interval [CI], 1.10 to 1.28) in patients with hyperthyroidism. Among the treatment modality groups, the RIA group (n=102) had a higher risk of diabetes than the ATD group (n=4,491) with HR of 1.56 (95% CI, 1.01 to 2.42). Further, the risk of diabetes increased with an increase in the ATD treatment duration (P for trend=0.019).
Conclusion: The risk of diabetes was significantly higher in patients with long-standing Graves’ disease than in the general population, especially in patients who underwent RIA and prolonged ATD treatment. Special attention to hyperglycemia during follow-up along with effective control of hyperthyroidism may be necessary to reduce the risk of diabetes in these patients.
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KEYWORD
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Hyperthyroidism, Graves disease, Diabetes mellitus, Antithyroid agents, Radioiodine ablation
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