Risk of Diabetes in Patients with Long-Standing Graves' Disease: A Longitudinal Study

Eyun Song; Min Ji Koo; Eunjin Noh; Soon Young Hwang; Min Jeong Park; Jung A. Kim; Eun Roh; Kyung Mook Choi; Sei Hyun Baik; Geum Joon Cho; Hye Jin Yoo

doi:10.3803/ENM.2021.1251

Risk of Diabetes in Patients with Long-Standing Graves' Disease: A Longitudinal Study

Eyun Song, Min Ji Koo, Eunjin Noh, Soon Young Hwang, Min Jeong Park, Jung A. Kim, Eun Roh, Kyung Mook Choi, Sei Hyun Baik, Geum Joon Cho, Hye Jin Yoo

Department of Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	1277-1286
Number of pages	10
Journal	Endocrinology and Metabolism
Volume	36
Issue number	6
DOIs	https://doi.org/10.3803/ENM.2021.1251
Publication status	Published - 2021 Dec

Keywords

Antithyroid agents
Diabetes mellitus
Graves disease
Hyperthyroidism
Radioiodine ablation

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Endocrinology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3803/ENM.2021.1251

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@article{1772c52b6b614038a2010344eb4b88ed,

title = "Risk of Diabetes in Patients with Long-Standing Graves' Disease: A Longitudinal Study",

abstract = "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.",

keywords = "Antithyroid agents, Diabetes mellitus, Graves disease, Hyperthyroidism, Radioiodine ablation",

author = "Eyun Song and Koo, {Min Ji} and Eunjin Noh and Hwang, {Soon Young} and Park, {Min Jeong} and Kim, {Jung A.} and Eun Roh and Choi, {Kyung Mook} and Baik, {Sei Hyun} and Cho, {Geum Joon} and Yoo, {Hye Jin}",

note = "Funding Information: This work was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number HR20C0021), the National Research Foundation of Korea funded by the Ministry of Education of Korea (2021R1A2C2008792), and the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 9991007469, KMDF_PR_20200901_0233). Moreover, this study used National Health Insurance Service data (NHIS-2020-1-098). The authors would like to thank all the staff of the National Health Insurance Sharing Service. Publisher Copyright: {\textcopyright} 2021 Korean Endocrine Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.",

year = "2021",

month = dec,

doi = "10.3803/ENM.2021.1251",

language = "English",

volume = "36",

pages = "1277--1286",

journal = "Endocrinology and Metabolism",

issn = "2093-596X",

publisher = "Korean Endocrine Society",

number = "6",

}

TY - JOUR

T1 - Risk of Diabetes in Patients with Long-Standing Graves' Disease

T2 - A Longitudinal Study

AU - Song, Eyun

AU - Koo, Min Ji

AU - Noh, Eunjin

AU - Hwang, Soon Young

AU - Park, Min Jeong

AU - Kim, Jung A.

AU - Roh, Eun

AU - Choi, Kyung Mook

AU - Baik, Sei Hyun

AU - Cho, Geum Joon

AU - Yoo, Hye Jin

N1 - Funding Information: This work was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number HR20C0021), the National Research Foundation of Korea funded by the Ministry of Education of Korea (2021R1A2C2008792), and the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 9991007469, KMDF_PR_20200901_0233). Moreover, this study used National Health Insurance Service data (NHIS-2020-1-098). The authors would like to thank all the staff of the National Health Insurance Sharing Service. Publisher Copyright: © 2021 Korean Endocrine Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

PY - 2021/12

Y1 - 2021/12

N2 - 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.

AB - 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.

KW - Antithyroid agents

KW - Diabetes mellitus

KW - Graves disease

KW - Hyperthyroidism

KW - Radioiodine ablation

UR - http://www.scopus.com/inward/record.url?scp=85123411031&partnerID=8YFLogxK

U2 - 10.3803/ENM.2021.1251

DO - 10.3803/ENM.2021.1251

M3 - Article

C2 - 34915605

AN - SCOPUS:85123411031

SN - 2093-596X

VL - 36

SP - 1277

EP - 1286

JO - Endocrinology and Metabolism

JF - Endocrinology and Metabolism

IS - 6

ER -

Risk of Diabetes in Patients with Long-Standing Graves' Disease: A Longitudinal Study

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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