Case Study
Volume 3 Issue 4 - 2020
Role of HbA1C in Diagnosis of Hypothyroidism in Diabetes Patients: A Case Study
Gayathri Choda1 and Gundu HR Rao2*
1Founder and CEO, Aarca Research Pvt. Ltd, Bengaluru, India
2Emeritus Professor, Laboratory Medicine and Pathology, Director, Thrombosis Research Institute, University of Minnesota, Minneapolis, Minnesota, USA
*Corresponding Author: Gundu HR Rao, Emeritus Professor, Laboratory Medicine and Pathology, Director, Thrombosis Research Institute, University of Minnesota, Minneapolis, Minnesota, USA.
Received: February 25, 2020; Published: March 16, 2020




Abstract

Incidence and prevalence of cardiometabolic diseases, have increased in the last four decades, to epidemic proportions worldwide. Despite a significant decline in the morbidity and mortality related, to cardiovascular diseases in industrialized nations, diabetes related deaths are on the rise. Patients with type-2 diabetes, suffer from a greater risk of vascular disease, often in association with dyslipidaemia. Majority of clinics, use fasting glucose or impaired glucose tolerance, to determine the progress of prediabetic state to that of diabetes. In view of the fact, that glycated haemoglobin A1c (HbA1c), represents three months average value of the glycemic load, it is used as the gold standard, to monitor the success or otherwise of the interventions, as well as progress or regression of the disease. Hypothyroidism causes many cardiometabolic abnormalities, as well as clinical symptoms, including insulin resistance, hypertension and dyslipidaemia, known features of type-2 diabetes. In this case report, we have presented our preliminary findings on, forty long-term diabetic subjects, less than 70 years of age and under regular supervised medical management. We have screened these patients, for vascular dysfunction using thermal imaging, to obtain risk scores for diabetes, hypertension and dyslipidaemia. Our study shows, that at clinically significant value of HbA1c (> 6.5), the observed values correlate well, with diabetes risk index. However, in some individuals with HbA1c greater than 9, the risk index is less than 3, indicating a moderate risk. In these patients, HbA1c seems to be independent of the state of diabetes condition, which is usually directly associated with HbA1c levels in type-2 diabetes. Results of these studies raise some very important questions on the role of glycemic load on treating diabetic patients with co-morbidities. What are the underlying mechanisms that promote vascular complications in diabetic patients with high levels of HbA1c? In the case of diabetic patients with comorbidities, is HbA1C sufficient for treatment? Further studies with a larger cohort, will provide answers to these very important questions related to the role of glycated proteins and lipids in the pathophysiology of endocrine disorders.

Keywords: HbA1C; Diabetes; Hypothyroidism

References

  1. NCD Risk Factor Collaboration (NCD-RisC). “Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 191 million participants”. Lancet 389 (2017): 37-55. 
  2. Reilly JJ., et al. “Determining the worldwide prevalence of obesity”. Lancet 391.10132 (2018): 1773-1774. 
  3. Global Burden of Metabolic Risk Factors for Chronic Disease Collaboration. “Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment”. The Lancet Diabetes and Endocrinology 2.8 (2014): 634-647. 
  4. NCD Risk Factor Collaboration. “Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 44 million participants”. Lancet 387.10027 (2016): 1513-1530.
  5. Kearnery PM., et al. “Global burden of hypertension: analysis of worldwide data”. Lancet 365.9455 (2005): 217-223.
  6. Nobre EL., et al. “Profile of the thyroid function in population with type-2 diabetes mellitus”. Endocrine Abstract 3 (2002): 298.
  7. Patrick L. “Iodine: Deficiency and therapeutic considerations”. Alternative Medicine Review 13.2 (2008): 116-127. 
  8. Lai Y., et al. “The relationship between serum thyrotropin and components of metabolic syndrome”. Endocrine Journal 58.1 (2011): 23-30. 
  9. Suskind DL. “Nutritional deficiencies during normal growth”. Pediatric Clinics of North America 56.5 (1993): 1035-1053. 
  10. Bernadette Biondi., et al. “Subclinical Hypothyroidism: A Review”. The Journal of the American Medical Association 322.2 (2019): 153-160.
  11. Monzani F., et al. “Does treating subclinical hypothyroidism improve markers of cardiovascular risk?” Treat Endocrinol 5.2 (2006): 65-81. 
  12. Constant EL., et al. “Cerebral blood flow and glucose metabolism in Hypothyroidism: A Positron Emission Tomography Study”. The Journal of Clinical Endocrinology and Metabolism 86.8 (2001):3864-3870. 
  13. Handisurya A., et al. “Effect of T4 replacement therapy on glucose metabolism in subjects with subclinical (SH) and overt hypothyroidism (OH)”. Clinical Endocrinology 69.6 (2008): 963-969.
  14. Yang G., et al. “Association between subclinical hypothyroidism and proliferative diabetic retinopathy in type-2 diabetic patients: A Case-Control Study”. Tohoku Journal of Experimental Medicine 222.4 (2010): 303-310.
  15. Anantarapu S., et al. “Effects of thyroid hormone replacement on glycated hemoglobin levels in non-diabetic subjects with overt hypothyroidism”. Archives of Endocrinology and Metabolism 59.6 (2015): 495-500. 
  16. Bhattacharjee R., et al. “Effect of thyroid status on glycated haemoglobin”. Indian Journal of Endocrinology and Metabolism 21.1 (2017): 26-30. 
  17. Makadia MG., et al. “Study of glycated haemoglobin (HbA1c) in non-diabetic subjects with subclinical Hypothyroidism”. Journal of Clinical and Diagnostic Research 11.4 (2017): BC01-04.
  18. Koner S and Chudhari A. “Assessment of glycosylated haemoglobin lee linage and blood glucose matched nondiabetic hypothyroid and euthyroid females in an urban population of Eastern India-An observational cross-sectional study”. International Journal of Research and Reviews 6 (2018): 2349-9788. 
  19. Sinha V and Kachhawa P. “Screening of subclinical hypothyroidism and glycosylated haemoglobin levels in healthy and subjects attending rural tertiary care centre in Western UP”. International Archives of BioMedical and Clinical Research 4.4 (2018): 39-42. 
  20. Mohamed GA and Elsayed AM. “Subclinical hypothyroidism ups the risk of vascular complications in type-2 diabetes”. Alexandria Journal of Medicine 53.3 (2017): 285-288. 
  21. Rao GHR. “Importance of studying disease and disease process”. Developments in Clinical and Medical Pathology 1 (2018): 1. 
  22. Rao GHR. “Integration of novel emerging technologies for the management of type-2 diabetes”. Archives of Diabetes and Obesity 1.1 (2018). 
  23. Rao GHR. “Diagnosis of early risk, management of risks, and reduction of vascular diseases”. Journal of Clinical Cardiology and Diagnostics 1 (2018): 1-11. 
  24. Rao GHR. “Flow Velocity, Fluid Dynamics and Vascular Pathology”. Scientific Pages of Heart 1 (2016): 001.
  25. Choda G and Rao GHR. “Diabetes related clinical complications: Novel approaches for diagnosis and management”. Journal of Clinical Cardiology and Diagnostics 2.2 (2019): 1-8. 
  26. Choda G and Rao GHR. “Thermal Imaging for early diagnosis of vascular dysfunction: A case report”. Journal of Clinical Cardiology and Diagnostics 2.2 (2019): 1-7. 
  27. Christy AL., et al. “Elevation of HbA1C in Non-diabetic Hypothyroid Individuals: Is Anaemia the Connecting Link? -A Preliminary Study”. Journal of Clinical and Diagnostic Research 7.11 (2013): 2442-2444. 
  28. Agarwal G., et al. “To see correlation of elevated HbA1c in hypothyroid individuals with anaemias: if any”. International Journal of Contemporary Medical Research 4.2 (2017): 77-83. 
  29. Canaris G., et al. “The Colorado Thyroid Disease Prevalence Study”. Archives of Internal Medicine 160.4 (2000): 526-534. 
  30. Inoue K., et al. “Association of subclinical hypothyroidism and cardiovascular disease with mortality”. The Journal of the American Medical Association 3.2: e1920745.
  31. Van Tienhowen-Wind LJN and Dullaart RPF. “Low-normal thyroid function and novel cardiometabolic biomarkers”. Nutrients 7.2 (2015): 1352-1377.
Citation: Gundu HR Rao., et al. “Role of HbA1C in Diagnosis of Hypothyroidism in Diabetes Patients: A Case Study”. EC Clinical and Medical Case Reports 3.4 (2020): 19-25.

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