In the Journals

Increased stress may influence higher prevalence of type 1 diabetes among transgender youths

The prevalence of type 1 diabetes among transgender and gender-nonconforming youths is more than nine times higher than that of the general population, with researchers exploring the role of increased psychological stress among adolescents with both diagnoses, according to findings from a single-center study published in Pediatric Diabetes.

Santhi N. Logel

“There is no reported association between type 1 diabetes and gender identity in adolescents,” Santhi N. Logel, MD, of the division of pediatric endocrinology and diabetes at the School of Medicine and Public Health at University of Wisconsin-Madison, and colleagues wrote in the study background. “However, a recent study in adults found a 2.3-fold higher prevalence of type 1 diabetes in patients seen in a transgender clinic. Given the overlapping challenges type 1 diabetes and transgender, nonbinary and gender-expansive/nonconforming youth face, identifying an association between type 1 diabetes and [gender identity] could further elucidate understanding of these two complex populations.”

Logel and colleagues analyzed electronic medical records data from children and young adults aged 10 to 21 years with a diagnosis of type 1 diabetes (n = 2,017) or gender dysphoria (n = 315) between November 2007 and November 2017, calculating prevalence rates for type 1 diabetes and gender dysphoria. For adolescents with type 1 diabetes and gender dysphoria, information related to diagnosis, treatment and psychiatric history was collected.

Researchers found that the prevalence for type 1 diabetes was 2.69 per 1,000 and the prevalence for gender dysphoria was 0.42 per 1,000. Eight adolescents had both type 1 diabetes and gender dysphoria.

Among adolescents with gender dysphoria, the prevalence of type 1 diabetes was 9.4-fold higher than the prevalence of type 1 diabetes observed in the general population (24.77 vs. 2.68 per 1,000; P < .0001).

Most patients with type 1 diabetes and gender dysphoria were diagnosed with type 1 diabetes before their first interaction with the gender clinic, with an average age at diagnosis of 10 years, according to researchers. Five adolescents were seen in a gender dysphoria clinic, and glycemic outcomes initially improved after the first clinic visit, according to researchers.

“While results of an EMR review should be interpreted with caution, these findings support those of a prior adult study reporting a higher prevalence of type 1 diabetes in patients seen in a transgender clinic,” the researchers wrote.

The researchers noted that adolescents with type 1 diabetes who received gender-affirming medical interventions experienced an initial improvement in glycemic outcomes that was not sustained.

“This finding suggests that stress reduction due to initiation of gender-affirming hormone therapy leads to short-term improvement in diabetes control in adolescents with type 1 diabetes and gender dysphoria,” the researchers wrote. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

The prevalence of type 1 diabetes among transgender and gender-nonconforming youths is more than nine times higher than that of the general population, with researchers exploring the role of increased psychological stress among adolescents with both diagnoses, according to findings from a single-center study published in Pediatric Diabetes.

Santhi N. Logel

“There is no reported association between type 1 diabetes and gender identity in adolescents,” Santhi N. Logel, MD, of the division of pediatric endocrinology and diabetes at the School of Medicine and Public Health at University of Wisconsin-Madison, and colleagues wrote in the study background. “However, a recent study in adults found a 2.3-fold higher prevalence of type 1 diabetes in patients seen in a transgender clinic. Given the overlapping challenges type 1 diabetes and transgender, nonbinary and gender-expansive/nonconforming youth face, identifying an association between type 1 diabetes and [gender identity] could further elucidate understanding of these two complex populations.”

Logel and colleagues analyzed electronic medical records data from children and young adults aged 10 to 21 years with a diagnosis of type 1 diabetes (n = 2,017) or gender dysphoria (n = 315) between November 2007 and November 2017, calculating prevalence rates for type 1 diabetes and gender dysphoria. For adolescents with type 1 diabetes and gender dysphoria, information related to diagnosis, treatment and psychiatric history was collected.

Researchers found that the prevalence for type 1 diabetes was 2.69 per 1,000 and the prevalence for gender dysphoria was 0.42 per 1,000. Eight adolescents had both type 1 diabetes and gender dysphoria.

Among adolescents with gender dysphoria, the prevalence of type 1 diabetes was 9.4-fold higher than the prevalence of type 1 diabetes observed in the general population (24.77 vs. 2.68 per 1,000; P < .0001).

Most patients with type 1 diabetes and gender dysphoria were diagnosed with type 1 diabetes before their first interaction with the gender clinic, with an average age at diagnosis of 10 years, according to researchers. Five adolescents were seen in a gender dysphoria clinic, and glycemic outcomes initially improved after the first clinic visit, according to researchers.

“While results of an EMR review should be interpreted with caution, these findings support those of a prior adult study reporting a higher prevalence of type 1 diabetes in patients seen in a transgender clinic,” the researchers wrote.

The researchers noted that adolescents with type 1 diabetes who received gender-affirming medical interventions experienced an initial improvement in glycemic outcomes that was not sustained.

“This finding suggests that stress reduction due to initiation of gender-affirming hormone therapy leads to short-term improvement in diabetes control in adolescents with type 1 diabetes and gender dysphoria,” the researchers wrote. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.