AIMS:To assess the potential years of life loss (PYLL) due to different causes of death among individuals with type 1 diabetes in Finland, and to identify factors associated with the leading causes of death contributing most to PYLL. METHODS:All 45,801 individuals with type 1 diabetes in the Finnish Diabetes Registry during the period 2018-2022 were included. Cause-of-death data were obtained from Statistics Finland. PYLL were calculated as the sum of deaths multiplied by the difference between age 80 and age at death. The incidence rate ratios for cause-specific mortality were estimated with multivariable Poisson regression. RESULTS:Diabetes-related deaths had the greatest impact on PYLL, with an average of 20.2 years of life lost per death, accounting for a total of 12,691 years of life lost, consisting of severe hypoglycaemia (657 PYLL), ketoacidosis (4380 PYLL) and complications of diabetes (7654 PYLL). Cardiovascular diseases (8630 PYLL), cancer (4549 PYLL) and alcohol- and substance-related causes (3146 PYLL) were the next largest contributors to PYLL. In the multivariable Poisson analysis, age at onset of diabetes, age at beginning of follow-up, HbA1c ≥ 64 mmol/mol (≥ 8%), LDL-cholesterol ≥ 2.6 mmol/l, renal risk group, recorded end-stage renal disease, cardiovascular diseases and alcohol or substance abuse were associated with diabetes-related mortality. CONCLUSIONS:These findings emphasise the need for intensified prevention strategies focusing on modifiable risk factors, timely detection and management of complications, and comprehensive support for individuals at increased risk to reduce premature mortality in type 1 diabetes.

BackgroundManaging patients with fatigue is a clinical challenge. Because fatigue is often reported in hypothyroidism, thyroid hormone (TH) therapy may sometimes be incorrectly considered for biochemically euthyroid individuals. This study aimed to evaluate the prevalence and determinants of this practice in different European countries.MethodsWe analyzed aggregate data from the THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) online survey. We analyzed responses from 5,695 members of 28 national endocrine/thyroid societies’ specialists to the statement: “Thyroid hormones may be indicated in biochemically euthyroid patients with unexplained fatigue”.ResultsOverall, 7.5% (426/5695) of respondents indicated that TH therapy might be considered for euthyroid patients with unexplained fatigue. The proportion of positive responses varied widely across different countries (between 1.1% in Switzerland and 29.3% in Serbia; p=2 ×10-16) and regions (between 4.7% in Western Europe and 8.7% in Western Asia or 8.8% in Eastern Europe; p=0.004). TH were more frequently prescribed for unexplained fatigue by male respondents (Odds Ratio, OR 1.45, 95% CI 1.18-1.78) and physicians practicing in private practice (OR 1.27, 95% CI 1.02-1.58), and less frequently by endocrinologists (OR 0.62, 95% CI 0.46-0.83).ConclusionA small, yet not negligible percentage of European thyroid-focused physicians consider using TH for euthyroid patients with unexplained fatigue, with significant variations based on geographic, demographic, and practice-related factors. Using levothyroxine and/or liothyronine in such cases lacks evidence and may partially contribute to the concerning overuse of TH therapy.

PurposeTreatment-resistant depression (TRD) is most commonly defined as depression that has not responded to two different pharmacological agents used for an adequate period of time. We explored the views of European specialists via survey, regarding the use of thyroid hormone (TH) in euthyroid patients with TRD as part of ‘Treatment of Hypothyroidism in Europe by Specialists: An International Survey’ (THESIS).MethodsThe question “Thyroid hormones may be indicated in biochemically euthyroid patients with treatment resistant depression” was posed to specialists from 28 countries.Results5695 valid responses were received following 17,232 invitations (33.0% response rate; 65% female, 90% endocrinologists). 348 (6.1%) stated that TH may be indicated in biochemically euthyroid patients with TRD. This view was more common in males (p<0.01), respondents who saw ≥100 patients with hypothyroidism per year (p<0.01), respondents who worked in private practice (p=0.05) and respondents who were not members of international specialist associations (p=0.05). Geographical variation existed with respondents in Eastern Europe significantly more likely to use TH in TRD (p<0.01). Linear regression showed a statistically significant reduction in the use of TH for TRD with increasing gross national income (F-statistic=7.35, CI -0.15 - -0.02, p=0.01). TH in TRD was recommended in psychiatry guidelines but not endocrinology guidelines.ConclusionWhile there is limited evidence for their use, over 6% of respondents stated that TH may be indicated in TRD. Due to the risk of iatrogenic thyrotoxicosis and increased morbidity the use of TH should be addressed in relevant endocrinology guidelines and consensus should be reached between specialties.

Aims We investigated the effect of 52-week liraglutide treatment on the incidence of type 2 diabetes (T2D) compared with placebo treatment in women with obesity and previous gestational diabetes (pGDM) requiring medical treatment. As secondary outcomes, the prevalence of prediabetes and glycaemic control were investigated. Methods Women were randomized to once daily subcutaneous liraglutide 1.8 mg or placebo for 52 weeks. Oral glucose tolerance test, C-peptide, insulin, HbA1c and lipids were determined at baseline, 26 weeks, and 52 weeks. Results In total, 75 women [mean age of 34.5 years, median BMI of 38.0 kg/m2] were assigned to liraglutide (n = 37) or placebo (n = 38). At 52 weeks, T2D was diagnosed in 3% (n = 1) of the liraglutide group and 8% (n = 2) of the placebo group (p = 0.58), and prediabetes in 27% (n = 9) and 58% (n = 15), respectively (p = 0.032). In intention-to-treat analysis, 52-week liraglutide treatment reduced fasting glucose [group × time interaction p = 0.0047; estimated treatment difference (ETD) at 52 weeks −0.5 mmol/L, p = 0.0020], HbA1c [p = 0.020; ETD -0.2% (−2.1 mmol/mol), p = 0.056], weight (p = 0.0087; ETD -6.2 kg, p = 0.20) and waist circumference (p = 0.022; ETD -3.9 cm, p = 0.25), and improved Matsuda index (p = 0.049; ETD 0.7, p = 0.011) compared with placebo. Conclusions Liraglutide reduces the prevalence of prediabetes and improves glycaemic control in women with obesity and pGDM. Due to few T2D cases, the effect of liraglutide on diabetes risk could not be reliably assessed.

Background and purpose: The purpose of this study was to evaluate the safety of omitting radioiodine (RAI) ablation in low-risk papillary thyroid cancer. Patients and methods: All five university hospitals in Finland consecutively and prospectively enrolled patients in the study with the following inclusion criteria: age 18 or over, papillary unifocal, intrathyroidal cancer 11–20 mm operated with a thyroidectomy, and no lymph node metastases. All patients were initially offered a follow-up without RAI. The patients who did not receive postoperative RAI were included in the RAILESS group. Those who preferred to have RAI and those who received RAI due to elevated thyroglobulin (TG) or thyroglobulin antibodies (TGAb) formed the RAIRINN group. Thyroglobulin and TGAb levels were monitored 4–8 weeks postoperatively in the RAILESS group. All patients were subsequently monitored every 3 months for the first year and then annually for 5 years, with a neck ultrasound. Radioiodine was administered if TG surpassed 2 ug/L or TGAb exceeded 40 kU/L in two consecutive measurements. An event was defined as a structural recurrence or a biochemical abnormality resulting in RAI treatment. The primary endpoint was the amount of patients who remained event-free during a 5-year follow-up. Results: Fifty-three of 60 patients enrolled were assigned to the RAILESS and 5 to the RAIRINN group. In the RAILESS group, 96% (51/53) remained event-free throughout 5 years, while 4% (2/53) required RAI due to increased TG or TGAb levels. In the RAIRINN group, one patient (1/7 or 14%) developed a metastatic disease. Interpretation: Our findings provide additional evidence for safely omitting postoperative RAI in low-risk papillary thyroid cancer.

OBJECTIVE:A relationship among hypothyroidism and lipid disorders is well established. However, current evidence and guidelines do not support the use of thyroid hormones (TH) in euthyroid patients with hyperlipidaemia as potential harms are considerable. This European survey investigated the use of TH in euthyroid patients with severe hypercholesterolemia as a complementary treatment. DESIGN:Data were derived from the THESIS (Treatment of Hypothyroidism in Europe by Specialists) project that surveyed TH use. Univariable and multivariable analyses were used to explore associations. RESULTS:Out of 17,232 invitations, 5695 (33.0%) valid responses were received, and of these, 328 (5.8%) stated that TH are indicated in euthyroid patients with severe hypercholesterolemia. Univariable analyses disclosed significant differences and associations: (a) more non-endocrinologists (8.9%) than endocrinologist (5.4%) used TH (p < 0.001), (b) the number of hypothyroid patients treated per year was inversely related to use of TH (p = 0.024), (c) members of international endocrine/thyroid societies were more likely to use TH than non-members (p < 0.001), (d) significant variations by country and geographical region (p < 0.001), and (e) inverse relationship between gross national income per capita (GNIPC) and TH use (p < 0.001). Multivariable analyses yielded significant associations between use of TH, and male gender, specialty and GNIPC (p < 0.001). CONCLUSIONS:This study suggests that a small but noteworthy minority of European thyroid specialists may be using TH to treat of severe hypercholesterolemia in euthyroid patients. If confirmed, this finding highlights the importance of raising awareness among thyroid specialists, professional societies, and healthcare providers to ensure adherence to evidence-based practices.

Abstract Background This study assessed the productivity costs and their progression with age among people with type 2 diabetes with or without co-occurring substance use disorders and depression.Methods The FinDM (Diabetes in Finland) database was searched for working age people with type 2 diabetes aged 30 or older (N = 377,560) and for possibly co-occurring comorbidities between 1998 and 2017. Annual productivity costs were estimated for each person using the friction cost and human capital methods. To analyse the age progression of annual mean costs and the impacts of type 2 diabetes and the comorbidity diagnoses on the costs piecewise linear regression models allowing for the divergence in costs at the times of diagnoses were employed. Two scenarios representing the progression of annual mean costs in typical (age 57) and early-onset (age 42) type 2 diabetes with or without co-occurring comorbidities were presented.Results People with type 2 diabetes and both comorbidities exhibited over sevenfold annual productivity costs at age 45 compared to those without these diagnoses (€6,320 vs €856). This difference decreased towards the statutory retirement age (63 years). Each additional year of age led to an increase of €29 in annual mean costs, however, reaching age 50 initiated an additional annual increase of €180. An additional year with type 2 diabetes, substance use disorder, and depression diagnosis contributed an additional €53, €195, and €202 to the annual mean costs, respectively. The early-onset scenario illustrated a divergence in costs among people with and without type 2 diabetes compared to those not yet diagnosed with the disease. The co-occurring comorbidities substantially amplified this divergence in mean annual costs. The human capital method provided nearly 10-fold larger estimates compared to the friction cost method at the cost peak at age 62.Conclusions Results show that co-occurring substance use disorders and depression substantially amplify productivity costs among people with type 2 diabetes. The results highlight the importance of identifying high-risk individuals and allocating the health care resources for their holistic and multidisciplinary care to sustain their work ability.

The use of thyroid hormones (TH) to treat obesity is unsupported by evidence as reflected in international guidelines. We explored views about this practice, and associations with respondent characteristics among European thyroid specialists. Specialists from 28 countries were invited to a survey via professional organisations. The relevant question was whether “Thyroid hormones may be indicated in biochemically euthyroid patients with obesity resistant to lifestyle interventions”. Of 17,232 invitations 5695 responses were received (33

Background: Hypothyroidism is common, however, aspects of its treatment remain controversial. Our survey aimed at documenting treatment choices of European thyroid specialists and exploring how patients' persistent symptoms, clinician demographics, and geo-economic factors relate to treatment choices.Methods: Seventeen thousand two hundred forty-seven thyroid specialists from 28 countries were invited to participate in an online questionnaire survey. The survey included respondent demographic data and treatment choices for hypothyroid patients with persistent symptoms. Geo-economic data for each country were included in the analyses.Results: The response rate was 32.9% (6058 respondents out of 17,247 invitees). Levothyroxine (LT4) was the initial treatment preferred by the majority (98.3%). Persistent symptoms despite normal serum thyrotropin (TSH) while receiving LT4 treatment were reported to affect up to 10.0% of patients by 75.4% of respondents, while 28.4% reported an increasing such trend in the past 5 years. The principal explanations offered for patients' persistent symptoms were psychosocial factors (77.1%), comorbidities (69.2%), and unrealistic patient expectations (61.0%). Combination treatment with LT4+liothyronine (LT3) was chosen by 40.0% of respondents for patients who complained of persistent symptoms despite a normal TSH. This option was selected more frequently by female thyroid specialists, with high-volume practice, working in countries with high gross national income per capita.Conclusions: The perception of patients' dissatisfaction reported by physicians seems lower than that described by hypothyroid patients in previous surveys. LT4+LT3 treatment is used frequently by thyroid specialists in Europe for persistent hypothyroid-like symptoms even if they generally attribute such symptoms to nonendocrine causes and despite the evidence of nonsuperiority of the combined over the LT4 therapy. Pressure by dissatisfied patients on their physicians for LT3-containing treatments is a likely explanation. The association of the therapeutic choices with the clinician demographic characteristics and geo-economic factors in Europe is a novel information and requires further investigation.

BACKGROUND:Treatment of simple goiter (SG) growing over time with thyroid hormone (TH) therapy is discouraged by international guidelines. PURPOSE:To ascertain views of European thyroid specialists about TH treatment for euthyroid patients with growing SG and explore associations with management choice. METHODS:Online survey on the use of TH for growing SG among thyroid experts from 28 European countries. RESULTS:The response rate was 31.5% (5430/17,247). Most respondents were endocrinologists. Twenty-eight percent asserted that TH therapy may be indicated in euthyroid patients with a growing SG. National and regional differences were noted, from 7% of positive responses in The Netherlands to 78% in Czech Republic (p < 0.0001). TH was more frequently prescribed by respondents over 40 years old (OR 1.77, 2.13, 2.41 if 41-50, 51-60, >60, respectively), and working in areas of former iodine insufficiency (OR 1.24, 95% CI 1.03-1.50). TH was less frequently prescribed by endocrinologists (OR 0.77, 95% CI 0.62-0.94) and respondents working in Southern Europe (OR 0.40, 95% CI 0.33-0.48), Northern Europe (OR 0.28, 95% CI 0.22-0.36) and Western Asia (OR 0.16, 95% CI 0.11-0.24) compared to Western Europe. Associations with respondents' sex, country, availability of national thyroid guidelines, and gross national income per capita were absent or weak. CONCLUSIONS:Almost a third of European thyroid specialists support treating SG with TH, contrary to current guidelines and recommendations. This calls for urgent attention.

AIMS:To assess the effect of comorbidities, risk classification for chronic kidney disease (CKD) according to albuminuria and eGFR, HbA1c and LDL-cholesterol levels on all-cause mortality in patients with type 1 diabetes (DM1). METHODS:The study included all 45,801 DM1 patients from the Finnish Diabetes Registry during 2018-2022. Mortality of patients with DM1 was compared with mortality in non-diabetic population in Finland by estimating standardized mortality rates (SMRs). Poisson regression model was used to estimate the effect of risk factors on the SMR. RESULTS:A total of 2469 patients died during follow-up. SMR for the total cohort was 1.84 (95 % CI 1.77-1.92) peaking at the age of 30-49 years. The coverage of HbA1c values was 98 %, that of LDL-cholesterol 94 %, and U-ACR and eGFR 80 %. In a multivariate analysis, assessing the effect on mortality, the rate ratio for end-stage renal disease was 2.66, cardiovascular diseases 1.92, mental and behavioural disorders 1.64, foot complications 1.51, high or very high risk for CKD 3.64, LDL-cholesterol ≥2.6 mmol/l 1.33, and HbA1c ≥8 % (64 mmol/mol) 1.27. CONCLUSIONS:There's substantial excess mortality due to DM1 in Finland. Interventions should focus on addressing both renal and cardiovascular risk factors but also pay more attention to mental health.

Background and objective: Studies on the outcomes of parathyroid surgery are scarce. The aim was to report the outcomes and to study the association between pre- and peri-operative information with the outcomes of patients operated for primary hyperparathyroidism. Methods: This was a retrospective, descriptive study with unselected patients treated surgically for primary hyperparathyroidism from a catchment population of 704,500 in Finland. Data were acquired from the electronic hospital registers based on parathyroid surgery procedure codes between 1 January 2017 and 31 December 2018. Preoperative data, surgical data, preoperative and postoperative laboratory values, histopathological findings, and postoperative clinical data were recorded. Results: During the 2-year study period, 149 patients with primary hyperparathyroidism were treated surgically with a 97% remission rate. Surgical complications included postoperative bleeding in two patients (1%) and vocal cord paralysis in one patient (0.6%). No postoperative infections were reported. Three patients (2%) developed postoperative hypoparathyroidism necessitating the use of alfacalcidol more than 1 month after surgery. Ionized calcium measured 0–1 days after surgery was not statistically significantly associated with remission or postoperative hypoparathyroidism. Serum parathyroid hormone (PTH) assessed 0–1 days postoperatively was associated with persistent disease, but not with postoperative hypoparathyroidism. The histopathological diagnosis was adenoma or hyperplasia in 112 patients (75%), atypical adenoma in 28 patients (19%), and carcinoma in five patients (3%). Patients with parathyroid carcinoma had higher preoperative ionized calcium and PTH values than those with adenoma or hyperplasia. Conclusions: Most patients who were operated due to primary hyperparathyroidism achieved normocalcemia after surgery, and the frequency of complications was low. Ionized calcium taken 0–1 days after surgery was not associated with remission of hyperparathyroidism or postoperative hypoparathyroidism. High postoperative serum PTH predicted persistent disease.

BackgroundBased on Finnish LDLR-founder variations, the prevalence of familial hypercholesterolemia (FH) in Finland is estimated to be at least 1:600. Patients with FH have increased risk of premature coronary artery disease (CAD) and thus the prevalence of FH is expected to be higher in this subgroup.ObjectiveTo assess the prevalence of monogenic FH in a Finnish cohort of patients with premature CAD and elevated low-density lipoprotein cholesterol (LDL-C) levels.MethodsAmong 28,295 patients undergoing angiography at Heart Hospital at Tampere University Hospital between 2007 and 2017, we identified 162 patients diagnosed with premature CAD (men aged <55 years and women aged <60 years) and history of high LDL-C (≥5 mmol/L) levels without secondary causes of hypercholesterolemia. Clinical probability of FH was estimated, and genetic testing of FH was carried out in 80 patients with informed consent.ResultsOf the 80 patients with premature CAD and history of high LDL-C levels, 70% were men; the age at diagnosis of CAD for male and female patients was 48 and 53 years, respectively. In total, 58 (73%) patients had probable (n = 54) or definite (n = 4) FH based on Dutch Lipid Clinic Network criteria. A pathogenic variant of FH was found in five (6%) patients. Prevalence of the genetically verified FH was 1:16. The FH variant was found in 75% of patients with definite FH.ConclusionsThe prevalence of genetically verified FH was 1:16 among patients with premature CAD and elevated LDL-C level, which is 38 times higher than the estimated prevalence of 1:600 in the general Finnish population.

OBJECTIVES:The use of levothyroxine (LT4) treatment aiming to improve fertility in euthyroid women with positive thyroid peroxidase antibodies (TPOAb) is not supported by the available evidence. The aim of the study was to document the use of LT4 by European thyroid specialists in such patients. DESIGN:The data presented derive from Treatment of Hypothyroidism in Europe by Specialists, an International Survey (THESIS), a questionnaire conducted between 2019 and 2021 to document the management of hypothyroidism by European thyroid specialists. Here, we report the aggregate results on the use of LT4 in infertile, euthyroid women with positive TPOAb. RESULTS:A total of 2316/5406 (42.8%) respondents stated that LT4 may be indicated in TPOAb positive euthyroid women with infertility. The proportion of those replying positively to this question varied widely across different countries (median 39.4, range 22.9%-83.7%). In multivariate analyses males (OR: 0.8; CI: 0.7-0.9) and respondents >60 years (OR: 0.7; 0.6-0.8) were the least inclined to consider LT4 for this indication. Conversely, respondents managing many thyroid patients ("weekly" [OR: 1.4; CI: 1.0-1.9], "daily" [OR: 1.8; CI: 1.3-2.4]) and practicing in Eastern Europe (OR: 1.5; CI: 1.3-1.9) were most likely to consider LT4. CONCLUSIONS:A remarkably high number of respondents surveyed between 2019 and 2021, would consider LT4 treatment in TPOAb positive euthyroid women with infertility. This view varied widely across countries and correlated with sex, age and workload, potentially influencing patient management. These results raise concerns about potential risks of overtreatment.

Objective: Hyperthyroidism increases cardiovascular morbidity and mortality, but the underlying mechanisms are not fully understood. In this study we compared non-invasive haemodynamics between 20 hyperthyroid patients and 60 euthyroid subjects. Methods: The measurements were performed median 6 days after the initiation of antithyroid medication when the patients were still hyperthyroid. Three controls matched for age, sex, body mass index, and smoking status were selected for each patient. Recordings were performed during rest and passive head-up tilt using whole-body impedance cardiography, radial pulse wave analysis, and finger blood pressure measurements. Results: Systolic and diastolic blood pressures in the aorta and radial artery were similar in hyperthyroid and euthyroid subjects, while finger blood pressure was 16/12 mmHg lower in hyperthyroidism (p<0.001). Pulse wave velocity and aortic pulse pressure were similar, but radial pulse pressure was ~5 mmHg higher in hyperthyroidism (p=0.040) due to augmented amplification (p=0.045). Systemic vascular resistance was reduced (-18%), whereas heart rate (+19 beats/min), cardiac index (+28%), and left cardiac work (+31%) were increased in hyperthyroidism (p<0.001). Subendocardial viability ratio, reflecting the balance between coronary perfusion and pressure load, was reduced by 19% in hyperthyroidism (p<0.001). Compared with euthyroid subjects, hyperthyroid patients presented with reductions in systolic and diastolic finger blood pressures (p<0.001), and higher increase in heart rate (p=0.014) during upright posture. Conclusions: Hyperthyroid patients exhibited hyperdynamic circulation, reduced vascular resistance, reduced peripheral but not central blood pressure, and higher pulse pressure amplification. Furthermore, left cardiac workload was increased in parallel with unfavourable changes in coronary perfusion conditions.

OBJECTIVE:Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries. METHODS:A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale. RESULTS:Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists. CONCLUSION:This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.

Aims: Women with a history of gestational diabetes (GDM) have an increased risk of developing type 2 diabetes (T2DM). We studied the risk for T2DM in women with and without GDM in relation to body mass index (BMI) and examined whether insulin treatment for GDM associates with the risk of developing T2DM. In addition, we investigated whether the risk of developing T2DM after GDM had changed in 15 years.Methods: We used data by linking four registers; Medical Birth Register, Hospital Discharge Register and Primary Care Register run by THL Finnish Institute for Health and Welfare, and Medical Reimbursement Statistics run by the Social Insurance Institution of Finland (Kela). Registry data were collected from 2005 to 2020. The follow-up started from woman's delivery in 2006-2020 and ended to the diagnosis of T2DM or December 2020. Cox proportional hazard modelling was used to estimate the effect of GDM exposure to T2DM. To assess whether the risk of developing T2DM after GDM had changed in 15 years, we compared the HR between years 2006-2008 and 2018-2020.Results: In total, 462 401 women were included in the study: 96 353 (21%) women had previous GDM. There were 5370 (1.2%) women who developed T2DM after childbirth during the follow-up. Among women with prior GDM, 3995 (4.1%) developed T2DM, while 1375 (0.4%) women without prior GDM developed T2DM during follow-up. The mean follow-up was 6.86 years (SD 4.21) for women with GDM and 9.07 years (SD 4.35) for women without GDM. The hazard ratio (HR) for developing T2DM after GDM was 18.49 (95% CI 17.39-19.67). The incidence of T2DM in women with a history of GDM began to rise almost steadily from the first year of follow-up. As BMI increased, T2DM incidence increased in both women with and without prior GDM but more in women with prior GDM. Insulin treatment had an independent association with increased risk of T2DM (HR 3.81, 95% CI 3.57-4.07). We did not observe any difference in HR between years 2006-2008 and 2018-2020.Conclusions: The relative risk for T2DM was 11-fold for women with previous GDM compared to women without previous GDM. A higher BMI and insulin treatment increased the risk of future diabetes. All measures to prevent the conversion of GDM to T2DM should be taken especially among women with overweight or obesity.

Aims: To assess the prognosis and risk factors for diabetic ketoacidosis (DKA) in Tampere University Hospital (Tays) in a retrospective case-control study.Methods: All 282 patients (age >= 15 years) treated for DKA in Tays during the period 2014-2020 were included. A total of 846 controls adjusted for age, gender, diabetes type and municipality, and without any DKA during follow-up were collected from the Finnish National Diabetes Registry. HbA1c, mental and behavioural disorders, and mortality obtained from the Finnish National Diabetes Registry were compared between patients with and without DKA.Results: Patients' median age was 36 years. Ten percent of the patients with DKA died during the median follow-up time of three years. Mortality rate was sixfold higher in patients with DKA than among the controls (OR 6.28; 95% CI 3.17-12.42). Patients with DKA had higher rates of substance abuse (OR 4.68; 95% CI 3.23-6.78) and depression (OR 2.24; 95% CI 1.58-3.18), and higher median HbA1c levels (84 vs. 61 mmol/mol, p < 0.001). Nineteen percent of the DKA patients (n = 53) had recurrent DKA.Conclusions: DKA is a strong indicator for premature death. Poor glycaemic control, depression and substance abuse are risk factors for DKA.(c) 2023 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

OBJECTIVE:The variability of thyroid function tests (TFTs) during antithyroid drug (ATD) therapy and its association with adverse health outcomes have not been previously studied. The aim of this study was to evaluate the association of TFT variability and cardiovascular morbidity during ATD therapy.DESIGN:Retrospective cohort study.PATIENTS AND MEASUREMENTS:Hyperthyroid patients (n = 394) treated with ATD therapy at Tampere University Hospital between March 2016 and December 2018 were followed up for a median time of 1.5 years (interquartile range 0.8-2.0). The coefficients of variation (CVs) of the follow-up thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) measurements were determined. The associations of TFT variability and baseline clinical factors with cardiovascular disease (CVD) -associated hospital visits were assessed with logistic regression analyses.RESULTS:In the multivariable analyses, age (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03-1.09), male gender (OR: 2.33, 95% CI: 1.03-5.28) and fT4-CV (OR: 1.02, 95% CI: 1.01-1.04) were independent risk factors for cardiovascular morbidity, whereas baseline positive thyrotropin receptor antibodies (TRAbs) were associated with lower cardiovascular morbidity (OR: 0.29, 95% CI: 0.14-0.61). When the patients with baseline TRAb positivity were studied separately, fT4-CV was associated with cardiovascular morbidity (OR: 1.03, 95% CI: 1.00-1.05).CONCLUSIONS:During ATD therapy, fT4 variability is associated with an increased cardiovascular morbidity. Although positive TRAbs are associated with a lower cardiovascular morbidity compared with hyperthyroidism with negative autoantibodies, the variability of fT4 is associated with cardiovascular morbidity also in patients with positive TRAbs.