Association between type 2 diabetes mellitus and hypothyroidism: a case–control study

Anas Awad Alsolami,1 Khalid Z Alshali,1 Marwan Ahmad Albeshri,1 Shikih Hussain Alhassan,1 Abdalrhman Mohammed Qazli,1 Ahmed Saad Almalki,1 Marwan A Bakarman,2 Abdel Moniem Mukhtar1 1Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Objectives: Type 2 diabetes mellitus (DM-II) is highly prevalent in Saudi Arabia and only few studies have assessed it as a risk factor for hypothyroidism. This study aimed to examine the association between DM-II and hypothyroidism. Subjects and methods: We conducted a hospital-based case–control study. As cases, we included all adults admitted to King Abdulaziz University Hospital (KAUH) with laboratory-confirmed hypothyroidism. As controls, we drew a random sample of patients admitted to the orthopedic clinic at KAUH with laboratory-confirmed absence of hypothyroidism. We extracted data from the medical records regarding age, sex, presence of DM-II, HbA1c, comorbidities, treatment, and complications. We used multivariate logistic regression to identify factors associated with hypothyroidism. Results: We included 121 cases and 121 controls. In comparison to controls, cases were older (P=0.005), had higher prevalence of DM-II (P<0.001), had higher levels of HbA1c (P=0.03), used insulin (P<0.001) and oral hypoglycemic drugs (P<0.001) more often, and suffered more often from hypertension (P<0.001), coronary artery disease (CAD) (P<0.001), stroke (P=0.04), diabetic foot (P<0.001), and nephropathy (P<0.001). According to multivariate regression, the risk of hypothyroidism was significantly increased among patients with DM-II (OR=4.14; 95% CI=20.20–7.80; P<0.001) and CAD (OR=14.15; 95% CI=1.80–111.43; P=0.01). Conclusion: Patients with DM-II were at increased risk of developing hypothyroidism. Adequate management and control of DM-II might reduce the risk of developing hypothyroidism. Further research using a prospective cohort study design is needed to confirm these findings. Key messages: Patients with DM-II had an increased risk of developing hypothyroidism. Keywords: hypothyroidism, diabetes mellitus, comorbidities, complication

Hospitalization rate and outcomes in patients with left ventricular dysfunction receiving hemodialysis

Marwan A Albeshri,1 Mohammed S Alsallum,1 Sulafa Sindi,1 Mohammed Kadi,1 Abdullah Albishri,2 Hanadi Alhozali,3 Kamal Alghalayini3 1College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2College of Medicine, King Abdulaziz University-Rabigh Branch, Rabigh, Saudi Arabia; 3Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia Introduction: Left ventricular dysfunction (LVD) is characterized as left ventricular ejection fraction (EF) below half of the systolic capacity of the left ventricle. Patients on hemodialysis have higher risk of developing LVD than the general population. Our aim was to assess hospitalization rate and outcomes in hemodialysis patients with LVD.Patients and methods: All patients ≥18 years old, who started hemodialysis therapy at King Abdulaziz University Hospital between January 2011 and December 2011, were identified using medical records of hemodialysis unit. Patients were then divided into three groups, according to their EF results prior to the initiation of hemodialysis, as patients with EF <40%, EF between 40% and 49%, and EF ≥50%. Patients were then followed for 5 years by reviewing their hospital records to assess their outcomes, hospital admissions, and length of hospital stay.Results: Analysis included 333 patients. Patients with EF <40% were 40, 36 patients with EF 40%–49%, and 257 patients had an EF >50%. Patients with EF <50% were significantly older than patients with EF >50% (P=0.002). Diabetes mellitus and hypertension were more prevalent in patients with EF <40% and EF 40%–49% when compared with patients with EF >50% (P<0.001, P=0.002). The average length of stay between the three groups was significantly different (P=0.007). Intensive care unit admissions were significantly different when comparing the three groups (P=0.013) and was found to be an independent risk factor for mortality in our patients. Half of the patients with EF <40% and 44% of patients with EF of 40%–49% died compared with only 27% of patients with EF >50% (P=0.002). However, Kaplan–Meier analysis showed no significant difference in the survival time among the three groups (P=0.845).Conclusion: Mortality and morbidity increased in patients with LVD on hemodialysis compared with patients with normal EF. Keywords: LVD, hemodialysis, mortality, hospitalization&nbsp