Prevalence of Sub-Clinical hypothyroidsim and its correlation with diabetic nephropathy in patients with type 2 diabetes mellitus at Kenyatta National Hospital

Abstract

Background: Numerous epidemiological studies show that patients with type 2 diabetes mellitus have a higher prevalence of subclinical hypothyroidism which may be associated with diabetic complications. Controversy however persists about the indications for its treatment and whether individuals with type 2 diabetes mellitus should be routinely screened for this dysfunction. Objective of the study: To determine the prevalence of Subclinical hypothyroidism and its correlation with Diabetic Nephropathy in patients with type 2 Diabetes Mellitus at the Kenyatta National Hospital. Methods: This was a descriptive cross- sectional study conducted among type 2 Diabetes mellitus patients attending the diabetes and endocrinology clinic at the Kenyatta National Hospital (KNH). Consecutive sampling was used to recruit 171 study participants without a previous history of thyroid disease. Serum TSH, free T4 and urinary albumin: creatinine ratio were measured. Estimated GFR (eGFR) (ml/min/1.73 m2) was calculated according to equation of the Modification of Diet in Renal Disease. Patients with serum TSH levels >5 mIU/L and normal free T4 were classified as having subclinical hypothyroidism. Diabetic nephropathy was defined as urinary albumin/creatinine ratio ≥300 mg/g and/or an eGFR <60 ml/min/1.73 m2 Results: The prevalence of subclinical hypothyroidism (SCH) was 6.4% among patients with type 2 diabetes mellitus. Patients with both Diabetic nephropathy and subclinical hypothyroidism were 2.3% of the total population. There is a weak inverse correlation between eGFR with TSH r=-0.021 (p>0.005) and a weak positive correlation between TSH and UACR r=0.034 (p>0.005). Conclusion and Recommendation: Subclinical hypothyroidism is not associated with diabetic nephropathy in type 2 diabetes mellitus. The study however presents evidence of subclinical hypothyroidism among patients with T2DM. To build up on this findings, exploratory studies are recommended on the causes of Subclinical hypothyroidism in patients with Diabetic Nephropathy.