Subclinical thyroid dysfunction and incident diabetes: a systematic review and an individual participant data analysis of prospective cohort studies
European Journal of Endocrinology, vol. 187, pp. S35–S46
Abstract
Objective: Few prospective studies have assessed whether individuals with subclinical thyroid dysfunction are more likely to develop diabetes, with conflicting results. In this study, we conducted a systematic review of the literature and an individual participant data analysis of multiple prospective cohorts to investigate the association between subclinical thyroid dysfunction and incident diabetes. Methods: We performed a systematic review of the literature in Medline, Embase, and the Cochrane Library from inception to February 11, 2022. A two-stage individual participant data analysis was conducted to compare participants with subclinical hypothyroidism and subclinical hyperthyroidism vs euthyroidism at baseline and the adjusted risk of developing diabetes at follow-up. Results: Among 61 178 adults from 18 studies, 49% were females, mean age was 58 years, and mean follow-up time was 8.2 years. At the last available follow-up, there was no association between subclinical hypothyroidism and incidence of diabetes (odds ratio (OR) = 1.02, 95% CI: 0.88-1.17, I2 = 0%) or subclinical hyperthyroidism and incidence of diabetes (OR = 1.03, 95% CI: 0.82-1.30, I2 = 0%), in age- and sex-adjusted analyses. Time-to-event analysis showed similar results (hazard ratio for subclinical hypothyroidism: 0.98, 95% CI: 0.87-1.11; hazard ratio for subclinical hyperthyroidism: 1.07, 95% CI: 0.88-1.29). The results were robust in all sub-group and sensitivity analyses. Conclusions: This is the largest systematic review and individual participant data analysis to date investigating the prospective association between subclinical thyroid dysfunction and diabetes. We did not find an association between subclinical thyroid dysfunction and incident diabetes. Our results do not support screening patients with subclinical thyroid dysfunction for diabetes. Significance statement: Evidence is conflicting regarding whether an association exists between subclinical thyroid dysfunction and incident diabetes. We therefore aimed to investigate whether individuals with subclinical thyroid dysfunction are more prone to develop diabetes in the long run as compared to euthyroid individuals. We included data from 18 international cohort studies with 61 178 adults and a mean follow-up time of 8.2 years. We did not find an association between subclinical hypothyroidism or subclinical hyperthyroidism at baseline and incident diabetes at follow-up. Our results have clinical implications as they neither support screening patients with subclinical thyroid dysfunction for diabetes nor treating them in the hope of preventing diabetes in the future.
Authors 30
-
Affiliation as printed
Graduate School for Health Sciences, University of Bern , Bern, Switzerland
Institute of Primary Health Care (BIHAM), University of Bern , Bern, Switzerland
-
Affiliation as printed
Institute of Primary Health Care (BIHAM), University of Bern , Bern, Switzerland
-
Affiliation as printed
Institute of Primary Health Care (BIHAM), University of Bern , Bern, Switzerland
-
University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen, the Netherlands
-
University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen, the Netherlands
-
Affiliation as printed
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, the Netherlands
Department of Internal Medicine, Erasmus MC , Rotterdam, the Netherlands
-
Affiliation as printed
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, the Netherlands
-
University of Bern · University of California, San Francisco
Affiliation as printed
Departments of Medicine and Epidemiology & Biostatistics, University of California , San Francisco, California, USA
Institute of Primary Health Care (BIHAM), University of Bern , Bern, Switzerland
-
Affiliation as printed
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania, USA
-
The University of Western Australia · Fiona Stanley Hospital
Affiliation as printed
Department of Endocrinology and Diabetes, Fiona Stanley Hospital , Perth, Australia
Medical School, University of Western Australia , Perth, Australia
-
The University of Western Australia · Sir Charles Gairdner Hospital
Affiliation as printed
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Perth, Western Australia, Australia
Discipline of Internal Medicine, Medical School, University of Western Australia , Perth, Australia
-
Affiliation as printed
Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Perth, Western Australia, Australia
-
Affiliation as printed
Department of Medicine and Surgery, University of Parma , Parma, Italy
-
National Institutes of Health · National Institute on Aging
Affiliation as printed
National Institute on Aging, National Institutes of Health , Baltimore, Maryland, USA
-
Jacobijn Gussekloo Aachen Department of Public Health and Primary Care Section Gerontology and Geriatrics Department of Internal Medicine
Leiden University Medical Center
Affiliation as printed
Department of Public Health and Primary Care, Leiden University Medical Center , Leiden, the Netherlands
Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center , Leiden, the Netherlands
-
Leiden University Medical Center
Affiliation as printed
Section Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center , Leiden, the Netherlands
-
Affiliation as printed
Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
-
Seoul National University · Seoul National University Bundang Hospital
Affiliation as printed
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Soeul, South Korea
-
Affiliation as printed
Translational and Clinical Research Institute, Newcastle University , Newcastle upon Tyne, UK
-
Hospital Universitário da Universidade de São Paulo
Affiliation as printed
Center for Clinical and Epidemiologic Research, University Hospital of São Paulo , São Paulo, Brazil
-
Research Institute for Endocrine Sciences · Shahid Beheshti University · Shahid Beheshti University of Medical Sciences
Affiliation as printed
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
-
Research Institute for Endocrine Sciences · Shahid Beheshti University · Shahid Beheshti University of Medical Sciences
Affiliation as printed
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
-
Instituto de Salud Carlos III · Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas · Hospital Regional Universitario de Málaga · Instituto de Investigación Biomédica de Málaga · Universidad de Málaga
Affiliation as printed
CIBERDEM, Instituto de Salud Carlos III , Madrid, Spain
Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga/Universidad de Málaga, Instituto de Investigación Biomedica de Málaga-IBIMA , Málaga, Spain
-
Instituto de Salud Carlos III · Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas · Hospital Regional Universitario de Málaga · Instituto de Investigación Biomédica de Málaga · Universidad de Málaga
Affiliation as printed
CIBERDEM, Instituto de Salud Carlos III , Madrid, Spain
Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga/Universidad de Málaga, Instituto de Investigación Biomedica de Málaga-IBIMA , Málaga, Spain
-
University of Cambridge · Wellcome/MRC Institute of Metabolic Science · MRC Epidemiology Unit
Affiliation as printed
MRC Epidemiology Unit, Institute of Metabolic Sciences, University of Cambridge , Cambridge, UK
-
Leiden University Medical Center · Netherlands Heart Institute
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Leiden, the Netherlands
Netherlands Heart Institute , Utrecht, the Netherlands
-
Affiliation as printed
Department of Public Health and Center of Healthy Ageing, University of Copenhagen , Copenhagen, Denmark
-
Seoul National University · Seoul National University Bundang Hospital
Affiliation as printed
Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences , Seoul, South Korea
Department of Neuropsychiatry, Seoul National University Bundang Hospital , Seongnam, South Korea
Department of Psychiatry, Seoul National University, College of Medicine , Seoul, South Korea
-
University of Bern · University Hospital of Bern
Affiliation as printed
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland
Institute of Primary Health Care (BIHAM), University of Bern , Bern, Switzerland
-
Affiliation as printed
Institute of Primary Health Care (BIHAM), University of Bern , Bern, Switzerland
Cited by 24 stored of 24
No patents citing this paper on Lens.org (checked 2026-10-11).