BACKGROUND
Diabetes is a condition where your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that leads to an increased risk for medical complications, both short term and long term, that can cause serious health problems, such as heart disease, vision loss, and kidney disease. Type 2 diabetes is by far the most common form and affects 46.3 million patients worldwide. Type 2 diabetes is a condition in which the body becomes resistant to insulin and is often associated with obesity. It is predominantly seen in adults and the incidence is increasing in the United States. This is in contrast to type 1 diabetes in which the insulin secreting cells are destroyed by antibodies and the body cannot produce any insulin and is usually seen in children and adolescents.

It is well established that thyroid hormones play a role in controlling metabolism, which are the chemical reactions in the body’s cells that change food into energy. Autoimmune thyroid disease is associated with type 1 diabetes, since they are both caused by antibodies that attack the body’s own cells, either the thyroid cells or the insulin producing cells of the pancreas. However, the relationship between thyroid problems and risk for type 2 diabetes is not well known. The purpose of this study is to evaluate the risk of early onset or adult type 2 diabetes in adolescents with thyroid disease.

THE FULL ARTICLE TITLE
Bardugo A et al. 2021. Adolescent thyroid disorders and risk for type 2 diabetes in young adulthood. J Clin Endocrinol Metab 106(9):e3426–e3435 PMID: 34050759.

SUMMARY OF THE STUDY
This was a nationwide study of 1,382,560 Israeli adolescents (average age 17.3 years) who were evaluated before military recruitment between 1988 and 2007 and were followed until the end of 2016. Pre-military recruitment evaluations included a medical interview and physical examination. The diagnosis of thyroid disorders was based on thyroid function blood tests and included euthyroid, hypothyroid and hyperthyroid disease. The diagnosis of diabetes was made with a gylcated hemoglobin (HbA1C) level > 6.5%, random blood glucose of 200 mg/dl or higher on two separate occasions at least one month apart, or the purchase of three or more medications to lower blood glucose.

There were 6,152 subjects with thyroid disease (48% euthyroid, 41% hypothyroid, 10% hyperthyroid). A majority were female (75%) and subjects were more likely to be overweight or obese when compared to those without thyroid disorders. During an average follow-up of 18.5 years, 1.12% of the adolescents with thyroid disease were also diagnosed with type 2 diabetes compared to 0.77% of those without thyroid dysfunction.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Thyroid disease in adolescents is a risk factor of adult onset of type 2 diabetes. This 2-fold increase risk of developing early onset type 2 diabetes in adolescents with thyroid disorders remained significant after correction for known variables such as sex, age, body-mass index, and socioeconomic status. It is important to understand the association between thyroid disease in adolescents and adult type 2 diabetes.

— Priya Mahajan, MD

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