Association between sensitivity to thyroid hormones and non-highdensity lipoprotein cholesterol levels in patients with type 2 diabetes mellitus

BACKGROUND Dyslipidemia and type 2 diabetes mellitus(T2DM)are chronic conditions with substantial public health implications.Effective management of lipid metabolism in patients with T2DM is critical.However,there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population,particularly concerning non-high-density lipoprotein cholesterol(non-HDL-C).AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM.METHODS In this cross-sectional study,thyroid hormone sensitivity indices,the thyroid feedback quantile-based index(TFQI),the thyroid-stimulating hormone index(TSHI),the thyrotrophic T4 resistance index(TT4RI),and the free triiodothyronine(FT3)/free thyroxine(FT4)ratio were calculated.Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels.Random forest variable importance and Shapley Additive Explanations(SHAP)summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor.RESULTS Among the 994 participants,389(39.13%)had high non-HDL-C levels.Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI(OR:1.584;95%CI:1.088-2.304;P=0.016),TSHI(OR:1.238;95%CI:1.034-1.482;P=0.02),and TT4RI(OR:1.075;95%CI:1.006-1.149;P=0.032)but was not significantly correlated with the FT3/FT4 ratio.The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex.An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men(OR:1.331;95%CI:1.003-1.766;P=0.048)but elevated TFQI levels in women(OR:2.337;95%CI:1.4-3.901;P=0.001).Among the analyzed variables,the average SHAP values were highest for TSHI,followed by TT4RI.CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.

Relapsed 6q24-related transient neonatal diabetes mellitus successfully treated with sulfonylurea

To the Editor:Neonatal diabetes mellitus(NDM)is defined as diabetes diagnosed within 6 months after birth and occurs in approximately one in every 90,000 to 160,000 live births,with an 80%yield due to a known genetic diagnosis.NDM can be classified as transient(TNDM),permanent(PNDM),or syndromic,in which TNDM accounts for approximately 45%of all cases of NDM.Overexpression of genes on chromosome 6q24 is the most common cause of TNDM(OMIM_601410),which accounts for approximately 70%of all cases and occurs by one of three mechanisms:(1)paternal uniparental disomy(41%),(2)duplication of paternal alleles(33%),or(3)hypomethylation of the maternal allele(26%)[1].

Compound heterozygous mutations in WFS1 cause atypical Wolfram syndrome

To the Editor: Wolfram syndrome (WS, MIM 222300) is a rare autosomal recessive disorder caused by mutations in WFS1 or CISD2 (WFS2). Its prevalence is estimated to be one in 160,000 to 770,000.[1] Patients usually present with insulin-dependent diabetes mellitus (DM) at around 6 years old and then with optic atrophy (OA) at around 11 years old. Other symptoms, such as diabetes insipidus, sensorineural deafness, urinary tract abnormalities, and neuropsychiatric disorders, occur at older ages and affect a fraction of individuals.