HKUMed researchers find a significant association between PHPT and the risk of developing diabetes. Pictured (from right) are Dr Matrix Fung Man-him, Dr David Lui Tak-wai, Dr Liu Xiaodong, Professor Brian Lang Hung-hin and Dr Paul Lee Chi-ho.
A groundbreaking study jointly led by the School of Clinical Medicine at the LKS Faculty of Medicine, of the University of Hong Kong (HKUMed), has found that surgical removal of the diseased parathyroid gland—known as parathyroidectomy—significantly reduces the risk of developing diabetes by 30% in patients with primary hyperparathyroidism (PHPT). The findings add to growing evidence that surgery could provide broader metabolic benefits beyond its known effects on calcium regulation. The study was published in JAMA Surgery [link to publication].
PHPT is the third most common endocrine disorder, following diabetes and thyroid diseases and affects thousands in Hong Kong and millions worldwide. Despite its prevalence, public awareness of PHPT remains limited, particularly regarding its potential link to metabolic diseases. PHPT is characterised by elevated calcium levels in the blood, which can lead to kidney stones and osteoporosis. Few people are aware that it may also impair blood sugar regulation.
Dr David Lui Tak-wai, Clinical Assistant Professor of the Division of Endocrinology in the Department of Medicine under the School of Clinical Medicine at HKUMed, said the parathyroid glands—distinct from the thyroid—are part of the body's endocrine system, and play a key role in regulating blood calcium levels. 'When calcium levels are low, the parathyroid glands secrete parathyroid hormone, which prompts the body to release calcium from the bones and enhances calcium absorption,' Dr Lui explained. 'While PHPT has long been associated with complications in the kidneys and bones, our study sheds light on its underappreciated metabolic consequences, especially its link to diabetes risk.'
Surgery linked to a 30% drop in diabetes risk
HKUMed researchers have analysed territory-wide electronic health records from Hong Kong, encompassing over 3,100 adult patients diagnosed with PHPT from 2006 to 2023. The team tracked the patients over a median follow-up period of nearly three years, using medical diagnoses, blood tests, and medication use to monitor the onset of diabetes.
The study found that patients who underwent parathyroidectomy—a surgical procedure to remove the diseased parathyroid glands—had a 30% lower risk of developing diabetes than those who did not have surgery. 'Parathyroidectomy was consistently associated with a lower risk of new-onset diabetes, and our findings remained robust with repeated validation and rigorous adjustments,' said Dr Liu Xiaodong from the Division of Endocrine Surgery, Department of Surgery, the School of Clinical Medicine at HKUMed. 'The benefit was particularly pronounced in younger patients and those with more severe PHPT.'
Call for awareness and early treatment of PHPT
'Parathyroidectomy may offer important metabolic benefits beyond the well-established protection for bones and kidneys,' said Dr Matrix Fung Man-him, Clinical Assistant Professor of the Division of Endocrine Surgery from the Department of Surgery under the same School. 'Excess parathyroid hormone can lead to increased calcium levels within cells, which may reduce insulin sensitivity and raise blood sugar levels. Surgery helps correct this hormonal imbalance, hence may improve blood glucose control. Our findings provide clinicians with stronger scientific evidence to guide treatment decisions.'
Dr Fung hoped that the study would raise the public awareness of PHPT and encourage early diagnosis and treatment, particularly among individuals at high risk of developing diabetes. This would allow more patients to benefit from the wide-ranging health improvements provided by surgery.
About the research team
This research was jointly led by Dr David Lui Tak-wai, from the Division of Endocrinology, Department of Medicine, and Dr Matrix Fung Man-him, from the Division of Endocrine Surgery, Department of Surgery, both under the School of Clinical Medicine, HKUMed.
