The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus

Aims Associated autoimmune phenomena might influence metabolic control in children and adolescents with Type 1 diabetes mellitus. A retrospective case control study was performed in order to explore the effect of subclinical hypothyroidism on metabolic control in Type I diabetes mellitus. Patients and methods For this purpose each patient with Type I diabetes and subclinical hypothyroidism (cases) was matched for age, duration of disease and, if possible, for sex, with two to three diabetic patients without hypothyroidism (controls). Parameters of metabolic control such as HbA(1c), total insulin requirement and frequency of symptomatic hypoglycaemia were retrieved for 12, 6 and 3 months before and after diagnosis of hypothyroidism. Results Thirteen patients (two male/11 female) patients were diagnosed with subclinical hypothyroidism and were matched with 31 controls (nine male/22 female). There was no difference (mean and range) in terms of age (11.9 years (4.4-18.1) vs. 11.7 years (3.5-18.1), P = 0.9) and duration of disease (5.1 years (1.2-10.5) vs. 4.38 years (0.9-10.8), P = 0.6) between the two groups. There was no difference in HbA(1c) and total insulin requirement between the two groups at any time point of assessment (ANOVA P = 0.8 and P = 0.1, respectively). Patients with hypothyroidism had significantly more symptomatic hypoglycaemic episodes during the 12 months before diagnosis (ANOVA P = 0.05), increasing progressively during this time period and reaching a peak at time 0 (5.5 +/- 0.4 vs. 1.6 +/- 0.1 episodes/month, P = 0.01). No difference could be detected within 6 months of starting substitution therapy (2.4 +/- 0.2 vs. 1.6 +/- 0.1 episodes/week, P = 0.8). Conclusions These data suggest that subclinical hypothyroidism is associated with an increased risk of symptomatic hypoglycaemia. The prompt introduction of substitution therapy is recommended as it reduces its frequency.