Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2025; 16(2): 98897
Published online Feb 15, 2025. doi: 10.4239/wjd.v16.i2.98897
Correlation between diabetic peripheral neuropathy and thyroid hormone sensitivity in elderly patients with type 2 diabetes mellitus
Si-Jia Fei, Jing-Yi Luo, Wei-Hao Wang, Li-Xin Guo, Qi Pan
Si-Jia Fei, Jing-Yi Luo, Wei-Hao Wang, Li-Xin Guo, Qi Pan, Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Co-corresponding authors: Li-Xin Guo and Qi Pan.
Author contributions: Pan Q, Guo LX and Fei SJ conceptualized and designed the research; Fei SJ, Luo JY and Wang WH screened patients and acquired clinical data; Fei SJ, Luo JY and Wang WH performed Data analysis; Fei SJ wrote the paper; All authors have reviewed and approved the final version of the manuscript for publication. Pan Q and Guo LX have both played essential and indispensable roles in the research design, data interpretation, and manuscript preparation as co-corresponding authors. Pan Q applied for and secured the funding for this research project. Pan Q conceptualized, designed, and supervised the entire project, conducted a literature review, and drafted the initial manuscript with a focus on the relationship between thyroid hormone sensitivity and diabetic peripheral neuropathy. Guo LX was instrumental in data re-analysis and interpretation, figure plotting, comprehensive literature review, and the preparation and submission of the current manuscript version, which focuses on FT3/FT4 as a potential predictor of peripheral neuropathy in elderly patients with type 2 diabetes. The collaboration between Pan Q and Guo LX is crucial for the publication of this manuscript.
Supported by the National Natural Science Foundation of China, No. 82270881 and No. 82200928; and National High-Level Hospital Clinical Research Funding, No. BJ-2023-124 and No. BJ-2023-130.
Institutional review board statement: This study received approval from the Research Committee of Beijing Hospital (No. 2024BJYYEC-KY094) and was conducted following the principles of the Declaration of Helsinki.
Informed consent statement: The requirement for written informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Pan, PhD, Chief Doctor, Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dahua Road, Dongcheng District, Beijing 100730, China. panqi621@126.com
Received: July 10, 2024
Revised: October 23, 2024
Accepted: November 26, 2024
Published online: February 15, 2025
Processing time: 174 Days and 1.4 Hours
Abstract
BACKGROUND

Diabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (T2DM), significantly affecting patients’ quality of life and imposing a substantial economic burden. Recent studies have highlighted the role of thyroid hormones in diabetes complications, particularly in elderly patients with T2DM. However, the relationship between thyroid hormone sensitivity and DPN remains unclear.

AIM

To investigate the correlation between thyroid hormone sensitivity and DPN in elderly patients with T2DM.

METHODS

In a cohort of 256 elderly patients with T2DM, propensity score matching was used to balance age, sex, and diabetes duration. Clinical data were collected to calculate thyroid hormone sensitivity and analyze its correlation with DPN. A random forest model was used to evaluate the diagnostic value of free triiodothyronine/free thyroxine (FT3/FT4) for DPN.

RESULTS

Patients with DPN had a lower FT3/FT4 ratio [ (0.302 ± 0.053) vs (0.316 ± 0.049), P = 0.040]. Quartile stratification showed decreasing DPN prevalence with higher FT3/FT4 ratios. Spearman’s correlation analysis showed that a lower FT3/FT4 ratio was associated with higher glycated hemoglobin, fasting blood glucose, reduced nerve conduction velocity, and electrical skin conductance. Logistic regression indicated a positive relationship between the median FT3/FT4 ratio and bilateral foot electrochemical skin conductance [odds ratio (OR): 1.019; 95%CI: 1.005-1.034; P = 0.007] and sural nerve sensory amplitude (OR: 1.310; 95%CI: 1.008-1.703; P = 0.043). Receiver operating characteristic analysis using a random forest model showed that incorporating FT3/FT4 improved predictive performance for DPN, with an area under the curve of 0.74, sensitivity of 0.79, specificity of 0.64, and accuracy of 0.77.

CONCLUSION

In elderly patients with T2DM with euthyroidism, a lower FT3/FT4 ratio is correlated with increased DPN incidence, affecting both large and small nerve fibers. FT3/FT4 is an effective predictor of DPN.

Keywords: Diabetic peripheral neuropathy; Thyroid hormone sensitivity; Type 2 diabetes mellitus; Elderly; Free triiodothyronine/free thyroxine ratio

Core Tip: In this study, we explore the relationship between thyroid hormone sensitivity and diabetic peripheral neuropathy (DPN) in elderly patients with type 2 diabetes mellitus (T2DM). Our findings indicate that a lower free triiodothyronine/free thyroxine (FT3/FT4) ratio is significantly associated with increased DPN incidence, affecting both large and small nerve fibers. The FT3/FT4 ratio serves as an effective predictor for DPN, enhancing diagnostic accuracy. These results highlight the importance of assessing thyroid hormone sensitivity in managing and predicting DPN in elderly patients with T2DM, offering new insights into the pathophysiological mechanisms underlying this complication.