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Inverse Association Between the Dawn Phenomenon and Thyroid Feedback Quantile-Based Index in Type 2 Diabetes Using

Yan Xia1, Hong-Jing Chen1, Reng-Na Yan2

  • 1Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, People's Republic of China.

Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy
|September 18, 2025
PubMed
Abstract

Insights

The dawn phenomenon in type 2 diabetes is linked to thyroid feedback efficiency and glycemic variability. Understanding this connection may lead to new therapies for managing morning hyperglycemia.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Diabetes Research

Background:

  • The dawn phenomenon, characterized by elevated blood glucose in the morning, is poorly understood in type 2 diabetes.
  • Current targeted therapies for the dawn phenomenon are unavailable.
  • Emerging evidence suggests thyroid dysfunction may influence glucose metabolism, potentially contributing to the dawn phenomenon.

Purpose of the Study:

  • To identify patients with type 2 diabetes experiencing the dawn phenomenon using continuous glucose monitoring (CGM).
  • To investigate the association between the dawn phenomenon and thyroid feedback efficiency.
  • To explore correlations with glycemic fluctuation and other clinical markers.

Main Methods:

  • Utilized CGM in 524 patients with type 2 diabetes to identify the dawn phenomenon (blood glucose elevation >1.11 mmol/L from 3 AM to 7 AM).
  • Collected clinical data including medications, complications, comorbidities, and biochemical markers (HbA1c, beta-cell function, thyroid function).
  • Employed propensity score matching to create a control group and performed regression analysis to identify predictors.

Main Results:

  • Over half of the patients (50.6%) exhibited the dawn phenomenon, which was associated with higher glycemic variability (SDBG, CV).
  • Thyroid feedback quantile-based index (TFQI) of free thyroxine (FT4) showed a negative correlation with morning glucose elevation (BG 3-7).
  • TFQI of free triiodothyronine (FT3) and low-density lipoprotein (LDL) were identified as independent predictors of morning glucose elevation.

Conclusions:

  • The dawn phenomenon in type 2 diabetes is significantly correlated with glycemic fluctuation severity and thyroid feedback efficiency.
  • These findings highlight the intricate relationship between thyroid hormones and glucose regulation, offering new insights into the dawn phenomenon's mechanisms.
  • Further research into thyroid function's role may pave the way for novel therapeutic strategies.
Keywords:
blood glucose variabilitydawn phenomenondiabetesthyroid hormones

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