Continuous glucose monitoring reveals thyroid feedback-related residual glycemic variability and hypoglycemia during inpatient glucose optimization in euthyroid adults with type 2 diabetes: a CGM-based observational study.
5 affiliations
- 1Department of Endocrinology and Metabolism, Shanghai Geriatric Medical Center, Chunshen Road 2560, Minhang District, Shanghai, 201104, China.
- 2Department of Nursing, Shanghai Geriatric Medical Center, Shanghai, 201104, China.
- 3Department of Endocrinology and Metabolism, Shanghai Geriatric Medical Center, Chunshen Road 2560, Minhang District, Shanghai, 201104, China. [email protected].
- 4Department of Endocrinology and Metabolism, Shanghai Geriatric Medical Center, Chunshen Road 2560, Minhang District, Shanghai, 201104, China. [email protected].
- 5Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. [email protected].
Abstract
Background
Continuous glucose monitoring (CGM) captures short-term glucose excursions and hypoglycemia beyond what HbA1c reflects, but endocrine traits that shape inpatient glycemic variability (GV) during therapy intensification are poorly defined. We evaluated whether thyroid feedback indices that proxy central thyroid hormone sensitivity are associated with CGM-derived residual GV and hypoglycemia in euthyroid inpatients with type 2 diabetes.Methods
We conducted a retrospective cohort study of 224 euthyroid adults with type 2 diabetes admitted for structured glucose optimization who wore blinded CGM for at least 6 consecutive days. Baseline FT3, FT4 and TSH were used to derive thyroid feedback indices (TFQI, TSHi and TT4RI). Daily CGM metrics were computed; Day 6 was prespecified as the primary later-inpatient analysis day at the cohort level. High GV was defined as Day 6 MAGE ≥ 3.9 mmol/L, and hypoglycemia as ≥ 2 consecutive readings < 3.9 mmol/L. Associations were tested using linear regression (including day-specific models) and multivariable logistic regression with sequential adjustment, including mean glucose and clinical covariates; post hoc sensitivity analyses additionally adjusted for available discharge medication classes.Results
Overall CGM profiles improved from Day 2 to Day 6 (TIR: 62 ± 25% to 84 ± 15%; MAGE: 6.34 ± 2.73 to 4.78 ± 2.04 mmol/L; both p < 0.001), while hypoglycemia still occurred in a subset. The TFQI-MAGE association increased in magnitude across inpatient days and was significant on Day 6 (β = 1.38, p < 0.001). In fully adjusted models, higher TFQI was associated with high GV (OR 3.11, 95% CI 1.27-7.60) and hypoglycemia (OR 4.78, 95% CI 1.56-14.63).Conclusions
In euthyroid adults with type 2 diabetes undergoing inpatient titration, higher thyroid feedback indices, particularly TFQI, were linked to greater residual CGM variability and a higher risk of hypoglycemia on the later inpatient day. These readily available indices may augment CGM-based inpatient risk stratification for monitoring intensity and titration pace; prospective studies incorporating treatment dose, timing, dietary intake and stress physiology are needed.Clinical trial registration
Not applicable.
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BibTeX
@article{alimujiang2026continuous,
title = {{Continuous glucose monitoring reveals thyroid feedback-related residual glycemic variability and hypoglycemia during inpatient glucose optimization in euthyroid adults with type 2 diabetes: a CGM-based observational study.}},
author = {Miriayi Alimujiang and Lei Zhang and Wenwen Chen and Shuai Ma and Jiejie Zhao and Qiyu Chen and Dilidaer Muhanhali and Peng Yu and Yan Ling},
journal = {BMC endocrine disorders},
year = {2026},
month = jul,
doi = {10.1186/s12902-026-02437-1},
url = {https://europepmc.org/article/MED/42928240},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Continuous glucose monitoring reveals thyroid feedback-related residual glycemic variability and hypoglycemia during inpatient glucose optimization in euthyroid adults with type 2 diabetes: a CGM-based observational study.
AU - Miriayi Alimujiang
AU - Lei Zhang
AU - Wenwen Chen
AU - Shuai Ma
AU - Jiejie Zhao
AU - Qiyu Chen
AU - Dilidaer Muhanhali
AU - Peng Yu
AU - Yan Ling
PY - 2026
DA - 2026/07/28
JO - BMC endocrine disorders
DO - 10.1186/s12902-026-02437-1
UR - https://europepmc.org/article/MED/42928240
AB - Background Continuous glucose monitoring (CGM) captures short-term glucose excursions and hypoglycemia beyond what HbA1c reflects, but endocrine traits that shape inpatient glycemic variability (GV) during therapy intensification are poorly defined. We evaluated whether thyroid feedback indices that proxy central thyroid hormone sensitivity are associated with CGM-derived residual GV and hypoglycemia in euthyroid inpatients with type 2 diabetes.Methods We conducted a retrospective cohort study of 224 euthyroid adults with type 2 diabetes admitted for structured glucose optimization who wore blinded CGM for at least 6 consecutive days. Baseline FT3, FT4 and TSH were used to derive thyroid feedback indices (TFQI, TSHi and TT4RI). Daily CGM metrics were computed; Day 6 was prespecified as the primary later-inpatient analysis day at the cohort level. High GV was defined as Day 6 MAGE ≥ 3.9 mmol/L, and hypoglycemia as ≥ 2 consecutive readings < 3.9 mmol/L. Associations were tested using linear regression (including day-specific models) and multivariable logistic regression with sequential adjustment, including mean glucose and clinical covariates; post hoc sensitivity analyses additionally adjusted for available discharge medication classes.Results Overall CGM profiles improved from Day 2 to Day 6 (TIR: 62 ± 25% to 84 ± 15%; MAGE: 6.34 ± 2.73 to 4.78 ± 2.04 mmol/L; both p < 0.001), while hypoglycemia still occurred in a subset. The TFQI-MAGE association increased in magnitude across inpatient days and was significant on Day 6 (β = 1.38, p < 0.001). In fully adjusted models, higher TFQI was associated with high GV (OR 3.11, 95% CI 1.27-7.60) and hypoglycemia (OR 4.78, 95% CI 1.56-14.63).Conclusions In euthyroid adults with type 2 diabetes undergoing inpatient titration, higher thyroid feedback indices, particularly TFQI, were linked to greater residual CGM variability and a higher risk of hypoglycemia on the later inpatient day. These readily available indices may augment CGM-based inpatient risk stratification for monitoring intensity and titration pace; prospective studies incorporating treatment dose, timing, dietary intake and stress physiology are needed.Clinical trial registration Not applicable.
SN - 1472-6823
ER -