Keywords
diabetes mellitus type 2
subclinical hypothyroidism
insulin resistance
How to Cite
Abstract
The degree of insulin resistance (IR) in elderly patients with comorbid course of hypertension (H) and diabetes mellitus 2 type (DM2T) with normal functional state of the thyroid gland (ThG) and subclinical hypothyroidism (SHT) have been assessed. The patients of three groups were investigated: 1st – with isolated H; 2nd – with H and DM2T; 3rd – with H, DM2T and SHT. All patients’ anthropometric data, indicators of lipid, carbohydrate and thyroid metabolism using standard methods, serum insulin levels and glycosylated hemoglobin – by enzyme immunoassay, insulin resistance – by HOMA-IR index were measured. It is shown, that the HOMA-IR index is significantly different between groups 2 and 3 and patients with isolated H, which is due to the synergistic negative effect on metabolic processes in comorbid pathology. In patients of group 2, higher fasting glucose levels and an HOMA-IR index than in patients of groups 1 and 3 are observed. Compensation of DM2T was associated with not only significantly lower levels of HOMA-IR, but a tendency to a decrease in TSH levels. A threshold value of TSH 6.5 μU/ml was revealed after which there was a significant increase in the IR index. In the combined course of H and DM2T against the background of subclinical hypofunction of the thyroid gland, IR is significantly less pronounced than with its normal function. Achievement of the DM2T compensation in such patients against the background of metformin is accompanied not only by a significant decrease in IR, but also by a tendency to a decrease in TSH blood levels. In the combined course of H, DM2T and SHT, subclinical levels of TSH which are accompanied by more relevant IR levels were found. This has to be taken into account in the overall cardiovascular risk assessment and, accordingly, the prognosis.
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