Idiopathic post prandial glucose lowering, a whistle blower for subclinical hypothyroidism and insulin resistance. A cross-sectional study in Tertiary Care Centre of northeast India

Chubalemla Longkumer; Chandan Kr Nath; Bhupen Barman; Alice Abraham Ruram; Vizovonuo Visi; M D Yasir; Merrycka Agitok Sangma

doi:10.4103/jfmpc.jfmpc_867_20

Idiopathic post prandial glucose lowering, a whistle blower for subclinical hypothyroidism and insulin resistance. A cross-sectional study in Tertiary Care Centre of northeast India

J Family Med Prim Care. 2020 Sep 30;9(9):4637-4640. doi: 10.4103/jfmpc.jfmpc_867_20. eCollection 2020 Sep.

Authors

Chubalemla Longkumer¹, Chandan Kr Nath¹, Bhupen Barman², Alice Abraham Ruram¹, Vizovonuo Visi³, M D Yasir¹, Merrycka Agitok Sangma⁴

Affiliations

¹ Department of Biochemistry, Neigrihms, Shillong-18, Meghalaya, India.
² Department of Medicine, Neigrihms, Shillong-18, Meghalaya, India.
³ Department of Community Medicine, Neigrihms, Shillong-18, Meghalaya, India.
⁴ Department of Physiology, Neigrihms, Shillong-18, Meghalaya, India.

Abstract

Background and aims: There has been a lot of confusion in management of apparently healthy individuals whose post prandial plasma glucose levels were lower than fasting levels. It has been observed that many clinicians do send for repeat tests to rule out analytical error since there is common knowledge that post prandial glucose should be higher than fasting glucose level. Blood glucose level is regulated by a fully integrated mechanism with complex interplay of hormones and enzymes on metabolic pathways. Increase or decrease of thyroid hormones can break this equilibrium leading to alterations of carbohydrate metabolism. The objective for this study was to look for subclinical hypothyroidism (SCH) and insulin resistance (IR) in Idiopathic Post prandial glucose lowering and the correlation between thyroid stimulating hormone (TSH) with IR in them.

Methods: A cross-sectional study with subgroup analysis, 34 cases and 34 controls. Cases comprises of otherwise healthy individuals whose post prandial glucose is lower than fasting glucose and controls as those healthy individual whose post prandial glucose is higher than fasting. Thyroid hormones and insulin were measured in fasting serum samples. Homeostasis model assessment for IR was calculated as per formula.

Results: Among the 34 cases with idiopathic post prandial glucose lowering, 76% (n = 26) had subclinical hypothyroidism and 61% (n = 21) had insulin resistance. A positive correlation (r = 0.55) was observed between Thyroid-Stimulating hormone (TSH) and Index of insulin resistance and homeostatic model assessment (HOMA-IR) and was statistically significant with P < 0.1.

Conclusions: The study highlights the importance of evaluating glycoregulatory hormones like thyroid hormones and insulin in cases with idiopathic post prandial glucose lowering for early diagnosis and prevention of overt clinical diseases like Hypothyroidism and Diabetes Mellitus.

Keywords: Idiopathic post prandial glucose lowering; insulin resistance; subclinical hypothyroidism; thyroid stimulating hormone.