Contrarily, it has been found that patients with poor glycemic control in T2DM have higher risk of subclinical hypothyroidism, possibly due to a stimulatory effect of higher leptin levels on the hypothalamic-pituitary-thyroid axis. Furthermore, treatment of hypothyroidism may improve insulin sensitivity. Triiodothyronine (T 3) has been shown to play a role in the protection of pancreatic island β-cells against apoptosis. Thyroid hormones have a large impact on glucose homeostasis, and both high and low thyroid hormone levels are associated with peripheral insulin resistance. The underlying pathophysiological mechanisms of the repeatedly reported association between thyroid dysfunction and type 2 diabetes (T2DM) have not yet been fully elucidated. Type 1 diabetes mellitus and auto-immune thyroid disease are associated through common auto-immune links. It has long been recognized that diabetes mellitus and thyroid disease, both common endocrine disorders, are closely related. There is no apparent relation between plasma TSH levels in the normal range and incident T2DM in patients at high cardiovascular risk. In the meta-analysis involving three prospective cohort studies, including the present study, including 29,791 participants with 1930 incident events, there was no relation between plasma TSH levels in the normal range and incident T2DM. In patients at high cardiovascular risk, higher plasma TSH levels in the normal range were not associated with an increased risk of T2DM, adjusted for age, sex, smoking, total and HDL cholesterol, and triglycerides. Hazard ratios (HR) from included prospective cohort studies were pooled using a random-effects model. ![]() MEDLINE, EMBASE, and Cochrane were searched for prospective cohorts assessing TSH and incident T2DM. Cox regression was used to investigate the relationship between baseline plasma TSH levels and incident T2DM. We included 5542 patients without T2DM from the prospective Secondary Manifestations of ARTerial disease study with TSH levels between 0.35 and 5.0 mIU/L without anti-thyroid medication or thyroid-hormone replacement therapy. To evaluate the relationship between thyroid-stimulating hormone (TSH) levels within the normal range and the risk of type 2 diabetes mellitus (T2DM) in a cohort of patients at high cardiovascular risk, and to perform a systematic review and meta-analysis of previous studies.
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