Abstract
Purpose :
Graves’ Ophthalmopathy (GO) can be disfiguring and vision threatening, and 90% of patients who have GO have underlying hyperthyroidism or Graves’ disease (GD). Teprotumumab is a novel therapy for GO that antagonizes IGF1-R and is highly effective, but studies have shown its association with hyperglycemia in over 50% of patients. As the baseline risk of hyperglycemia in GD has not been well characterized, we aim to evaluate the risk of developing new onset prediabetes, type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D) in patients with underlying GD using a retrospective cohort study.
Methods :
Our study utilized data from the TriNetX Global Collaborative Network, an aggregated electronic health records research network. ICD-10 coding was used to identify GD patients. A control cohort of non-GD patients was identified by ICD-10 coding for a general adult medical examination without abnormal findings and excluded by both ICD-10 and CPT coding for disorders and procedures of the thyroid gland. Patients were excluded from either cohort if they had any history of oral or intravenous steroid use, pre-existing hyperglycemia or any diabetes medication use prior to a diagnosis code. These cohorts were propensity score matched (PSM) for age, sex, race, and ethnicity. Main outcomes included risk of developing prediabetes, T1D, or T2D by ICD-10 codes at 1 year, 3 years, 5 years, and any time after a GD diagnosis. Univariate analyses were performed and risk ratios (RR) with 95% confidence intervals (CI) were calculated.
Results :
There were 147,179 patients in each cohort after PSM. Patients with GD had a higher risk of developing prediabetes (RR [95% CI] = 2.03 [1.90, 2.19]; p < 0.0001), T1D (RR [95% CI] = 4.35 [3.50, 5.40]; p < 0.0001) and T2D (RR [95% CI] = 2.35 [2.23, 2.48]; p < 0.0001) in the first 5 years compared to a matched control cohort. In subgroup analyses, GD patients aged 19-40 had the highest risk of developing T1D (RR [95% CI] = 8.36 [4.80, 14.54; p < 0.0001] and T2D (RR [95% CI] = 2.41 [2, 2.90]; p < 0.0001) compared to matched controls.
Conclusions :
GD patients have a higher risk of developing prediabetes, T1D and T2D than matched controls. Providers should be aware of these risks when treating patients who have underlying GD with IGF1-R inhibition, a mechanism also known to cause hyperglycemia. Multidisciplinary follow up with an endocrinologist should be considered in high-risk patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.