Previous studies have suggested an increased prevalence of diabetes in patients with primary hyperparathyroidism (PHPT). Potential mechanisms include hypercalcaemia-related insulin resistance and decreased insulin sensitivity due to 1,25-dihydroxyvitamin D deficiency.

To characterise the association further, Zhang et al. undertook a population-based retrospective cohort study involving 2,749 patients with PHPT and 13,745 age-, sex- and index year-matched individuals without PHPT. In their series between 2000 and 2019, patients with PHPT had 15% higher risk of incident diabetes compared with matched individuals without PHPT. In patients with PHPT, a 44% higher risk of incident diabetes was found in subjects with serum calcium concentrations above the median value (2.63mmol/l), compared to those with levels below the median value. Amongst patients with PHPT, there was a positive linear relationship between serum calcium concentration and the risk of incident diabetes.

Based on these findings, the authors demonstrate that patients with PHPT have a higher risk of incident diabetes compared with individuals without PHPT. Hence, they advise regular screening for dysglycaemia in patients with PHPT.

Read the full article in Clinical Endocrinology 101 605–613 https://doi.org/10.1111/cen.15118