Heart Risk With Gender-Affirming Tx; Burden of Thyroid Eye Disease; T1D Care Gaps

The best regimen for oral osilodrostat (Isturisa) dosing, COVID-19 risk in diabetes, and high frequency spinal stimulation for diabetic neuropathy pain were just some of the research advancements in endocrinology presented at the American Association of Clinical Endocrinology (AACE) virtual meeting. Below are a few more AACE research highlights.

Heart Risk With Gender-Affirming Hormones

In a retrospective study of 129 transgender individuals receiving gender-affirming hormone therapy, certain hormones affected metabolic parameters.

Specifically looking at transgender males receiving testosterone, there was an average 2.5% drop in HDL cholesterol levels seen each year of using gender-affirming hormone therapy (P=0.03). However, this change wasn’t seen in transgender females on estradiol during the average 48-month follow-up period. There were also no significant changes in LDL cholesterol, triglycerides, HbA1c, or 25-hydroxyvitamin D levels in transgender males or transgender females.

About 53% of the participants in the study identified as transgender males, and more than 60% of the cohort was white. The median age of the total cohort was 26 with a BMI of 25.5. The majority of transgender males were on intramuscular injectable preparations of testosterone cypionate.

“Further long-term data is needed for patients receiving this hormone therapy to assure that their long-term cardiovascular risk is optimized,” said Samihah Ahmed, MD, MBA, of Northwell Health Lenox Hill Hospital in New York City.

Active vs Inactive Thyroid Eye Disease

Inactive thyroid eye disease (TED) is still a substantial physical and mental burden to patients.

Rates of anxiety and/or depression were similar between 307 patients with active TED versus 281 patients with inactive disease. Likewise, the overall quality of life impact of TED was high for both active and inactive disease patients.

Specific symptoms were more prevalent in active TED patients, most commonly ocular dryness/grittiness (91.9%), soft tissue swelling (91.9%), conjunctival redness (89.6%), eyelid redness (79.5%), proptosis (78.2%), and excessive tearing (71.7%). Ocular dryness/grittiness and proptosis were also commonly reported in those with inactive disease (77.2% and 55.5%, respectivey).

All participants had physician-identified moderate-to-severe TED. To classify active versus inactive disease, Clinical Activity Score measures were used, drawing upon patient chart data. Those with a score of 0 or 1 were classified as inactive, while a score of 3 or higher was considered active.

“These data strongly suggest that proptosis, orbital changes, and vision dysfunction that develop during active TED persist into the inactive phase,” said Lissa Padnick-Silver, PhD, of Horizon Therapeutics in Deerfield, Illinois, which markets TED treatment teprotumumab (Tepezza). “Chronic TED is generally thought of as inactive and stable, but persistence of ocular signs and symptoms, along with long term quality of life impairment make TED seem anything but inactive, especially to the patient.”

Transitioning T1D Care

Certain clinical practices helped patients with type 1 diabetes transition more smoothly from pediatric to adult care.

In a retrospective, longitudinal study of 299 adolescents and young adults with type 1 diabetes, those who did not have a certified diabetes education as part of their care team were more likely to experience a gap in care while transitioning to an adult-oriented healthcare system. Also, patients who didn’t have a nutritionist as part of their care team, and those who were not using a continuous glucose monitoring were also more likely to experience a gap in care.

On the other hand, HbA1c, insulin pump use, other comorbidities, and yearly emergency department and hospital visits were not significantly tied to care gap.

The study looked at patients of the pediatric and adult endocrinology clinics at the Duke University Health System. This patient population was about half female and 73% white. The average HbA1c at the last pediatric care visit was 9.4%.

“The period of emerging adulthood is challenging for youth with type 1 diabetes,” said Diana Soliman, MD, of Duke University Health System in Durham, North Carolina. “The gaps in diabetes care can result in worse glycemic control, an increase in complications, and also emotional challenges.”

“A team-based approach with diabetes educators can help keep the youth engaged in their care,” she stated.