Complications of Type 2 Diabetes

Hypothyroidism Is a Risk Factor for DM Patients.
• Hypothyroidism is a risk factor for new onset DM, according to a large cohort study.
• The researchers matched up 39,263 statin nonusers with 20,334 highly compliant statin initiators in 2004–2005 and followed them until the end of 2010.
• In a multivariable model, hypothyroidism and subclinical hypothyroidism carried an increased risk for DM.

Statin Users Have a Higher Risk.
• The risk of DM with hypothyroidism was higher among statin users (relative risk (RR) 2.06) than for statin nonusers (RR 1.66).
• Subclinical hypothyroidism risk for DM was prominent only in statin users (RR 1.94) and not nonusers (RR 1.20).
• Patients with hypothyroidism treated with thyroid hormone replacement therapy were not at increased risk for DM.
• The researchers suggest that identifying and treating hypothyroidism and subclinical hypothyroidism might reduce the risk of DM.

Hypoglycemia Associated with Depression in Type 2 DM.
• Severe hypoglycemia is associated with depressive symptoms in Japanese patients with type 2 DM, according to a new cross-sectional study.
• These researchers investigated the relationship of the severity of depressive symptoms with clinical parameters, including an episode of severe hypoglycemia, in 4,218 Japanese patients with type 2 DM.
• After multivariate adjustments, the severity of depressive symptoms was significantly associated with body mass index, leisure-time physical activity, current smoking, sleep duration, sucrose intake, skipping breakfast, insulin use, severe hypoglycemia, dysesthesia of both feet, history of foot ulcer, photocoagulation, ischemic heart disease, and stroke.

Severe Hypoglycemia Increases with Severe Depression.
• For 2,756 sulfonylurea and/or insulin-treated patients, the risk for severe hypoglycemia increased significantly with their depression score.
• The association of severe hypoglycemia with depression may have great impact on the prognosis in patients with type 2 DM.
• Since severe hypoglycemia and depression are known risk factors for morbidity and mortality in patients with diabetes, clinicians should be aware of this combination.

HbA1c Associated with Risks of MI.
• HbA1c variables are associated with MI risk, according to a large cohort study.
• These researchers examined the risk of MI by impaired glycemic control in a cohort of 101,799 patients with type 2 DM who were diagnosed between 1995 and 2001.
• The patients were divided into an early cohort (diagnosed from 1997 and 2004) and a recent cohort (diagnosed from 2004 to 2011).
• The correlation between three HbA1c metrics and MI was examined.

Increased Risks for HbA1c less than 6%.
• The risk increase for MI per 1% increase in HbA1c was higher for updated latest and updated mean HbA1c than for baseline HbA1c in the overall cohort.
• The corresponding risk estimates were greater in the early versus the recent cohort.
• In the recent cohort, but not the early cohort, the updated latest variable showed an increased risk for HbA1c less than 6%.
• The 2 time-updated HbA1c variables show stronger associations with risk of MI than baseline HbA1c, and the association between HbA1c and risk of MI has decreased over time.

Take-home Messages.
• Hypothyroidism is a risk factor for DM, with a subclinical hypothyroidism-associated risk for DM prominent only in statin users.
• The combination of severe hypoglycemia and depression are known risk factors for morbidity and mortality in patients with type 2 DM.
• In recently diagnosed patients with type 2 DM, an increased risk of MI exists at a current HbA1c of less than 6%.