Insulin resistance and lipid alterations in subclinical hypothyroidism

Introduction: It is known that dyslipidemia and increased insulin resistance were associated with overt hypothyroidism, but their association with subclinical hypothyroidism is conflicting. Aim was to evaluate insulin resistance and lipid alterations in subclinical hypothyroidism. Methods: Fifty consecutive cases of subclinical hypothyroidism are the subjects of the study. The cases are compared with age, gender and BMI matched controls. Lipid profile, insulin levels, FPG are assessed after overnight fast. Insulin resistance is calculated using HOMA-IR . The correlation between TSH& lipid prolife, TSH & IR was assessed. Results: Total cholesterol (169.37±32.83 vs. 154.5±18.71, p= 0.031) & low density lipoprotein cholesterol (105.76±26.92vs 93.80±16.67, p=0.037) were significantly higher in cases compared to controls. High density lipoprotein cholesterol (44.23±4.65 vs 42.26±3.20, p=0.0507) was lower in cases which showed a trend towards significance. Triglycerides (97.64±39.44 vs. 92.96±43.49,p=0.65) , fasting insulin levels (11.74±7.16 vs 9.77±5.54,p=0.211) and Insulin resistance (2.30±1.49 vs. 1.78±1.09, p=0.11) were elevated but did not differ significantly between the two groups. Conclusion: Subclinical hypothyroidism is associated with elevation of TC , LDL-C and non significant increase in TG and insulin resistance. Both lipid profile and insulin resistance did not correlate with severity of hypothyroidism

Comparison of electrochemical skin conductance and vibration perception threshold measurement in the detection of early diabetic neuropathy

<div><p>The early diagnosis of diabetic peripheral neuropathy (DPN) is challenging. Sudomotor dysfunction is one of the earliest detectable abnormalities in DPN. The present study aimed to determine the diagnostic performance of the electrochemical skin conductance (ESC) test in detecting early DPN, compared with the vibration perception threshold (VPT) test and diabetic neuropathy symptom (DNS) score, using the modified neuropathy disability score (NDS) as the reference standard. Five hundred and twenty-three patients with type 2 diabetes underwent an NDS-based clinical assessment for neuropathy. Participants were classified into the DPN and non-DPN groups based on the NDS (≥ 6). Both groups were evaluated further using the DNS, and VPT and ESC testing. A receiver-operator characteristic (ROC) curve analysis was performed to compare the efficacy of ESC measurements with those of DNS and VPT testing in detecting DPN. The DPN group (n = 110, 21%) had significantly higher HbA1c levels and longer diabetes durations compared with the non-DPN group (n = 413). The sensitivity of feet ESC < 60 μS, VPT testing, and DNS in detecting DPN were 85%, 72%, and 52%, respectively. The specificity of feet ESC, VPT, and DNS in detecting DPN were 85%, 90% and 60% respectively. The areas under the curves of the ROC plots for feet ESC, VPT testing, and DNS were 0.88, 0.84, and 0.6, respectively. A significant inverse linear relationship was noted between VPT and feet ESC (r = -0.45, p = <0.0001). The odds ratios for having DPN, based on the mean feet ESC testing < 60 μS, VPT testing > 15 V, and DNS ≥ 1, were 16.4, 10.9 and 1.8, respectively. ESC measurement is an objective and sensitive technique for the early detection of DPN. Feet ESC measurement was superior to VPT testing for identifying patients with early DPN.</p></div

Baseline characteristics of the study population according to the presence or absence of DPN.

<p>Baseline characteristics of the study population according to the presence or absence of DPN.</p

Odds ratio (95% CI) of having DPN according to the feet ESC, VPT, and DNS values.

<p>Odds ratio (95% CI) of having DPN according to the feet ESC, VPT, and DNS values.</p

Percentages of abnormal DNS scores, and VPT or feet ESC measurements in patients with DPN, as defined by NDS ≥ 6 (n = 110).

<p>DNS—diabetic neuropathy symptom score, n = 59 (54%). VPT- vibration perception threshold, n = 79 (72%). Feet ESC- feet electrochemical skin conductance, n = 93 (84%).</p

Diagnostic performance of the feet ESC, VPT, and DNS in detecting DPN.

<p>Diagnostic performance of the feet ESC, VPT, and DNS in detecting DPN.</p

Receiver operating characteristics (ROC) curves for the DNS, feet ESC, and VPT scores, for detecting DPN, considering NDS ≥ 6 as the reference standard.

<p>DNS–diabetic neuropathy symptom score, VPT–vibration perception threshold, Feet ESC–feet electrochemical skin conductance.</p