Study Details Impact of Diabetes on Disease Presentation Among Patients with Thyroid Eye Disease

Patrick Campbell

Analysis of claims data from the Symphony database offers clinicians greater insight into the impact of diabetes, both type 1 and type 2, on thyroid eye disease in US patients.

An analysis of claims data from US-based patients is providing an overview of the impact diabetes status on patients with thyroid eye disease.

Results of the analysis, which were presented at the American Academy of Clinical Endocrinology’s 30th Annual Meeting (AACE 2021), detail the impact of diabetes status on disease presentation and also on rates of disease complications.

“Our data suggest that TED may manifest differently in patients with and without diabetes mellitus. In patients with diabetes mellitus (both type 1 and 2), proptosis was observed less often and eye muscle dysfunction observed more often as compared with TED patients without diabetes mellitus,” wrote investigators. “In addition, TED severity differed between TED patients with diabetes mellitus versus those without diabetes mellitus.”

Conducted by Lissa Padnick-Silver, PhD, and colleagues from Horizon Therapeutics, who owns the rights to teprotumumab (Tepezza), the AACE 2021 study was designed as an analysis of data from the Symphony database. Using this database, investigators hoped to identify patients with 1 or more ICD-9 codes for Graves’ orbitopathy and thyroid eye disease and enrolled within the databases for at least 2 years. The thyroid eye disease code algorithm for proptosis, diplopia, lid retraction, strabismus, exposure keratopathy, and optic neuropathy in patients with Graves orbitopathy.

For the purpose of analysis, patients were stratified based on presence/absence of diabetes codes and thyroid eye disease codes. Investigators also pointed out patients with sight-threatening thyroid eye disease, which was defined as 1 or more ON or exposure keratopathy codes, were identified and examined in a severity assessment.

Investigators identified a cohort of 51,220 patients with both Graves orbitopathy and thyroid eye disease. Among these patients, 5.1% had type 1 diabetes, 25.1% had type 2 diabetes, and the remaining 69.8% were considered nondiabetic. Compared to those without diabetes (51.4 years), patients type 1 diabetes (59.0 years) and type 2 diabetes (59.6 years) were older at time of first thyroid eye disease diagnosis.

Upon analysis, results indicated proptosis appeared to be less prevalent among patients with diabetes (T1D: 42%; T2D: 46% vs 59%), but an increased prevalence was seen for strabismus (25%; 23% vs 20%) and diplopia (39%; 38% vs 30%) was seen among patients with diabetes (P for all <.001). Incidence of sight-threatening thyroid eye disease was more common among patients with type 1 (13%) and type 2 diabetes (13%) compared to those without diabetes (11%).

When examining sight-threatening codes separately, results indicated more patients with diabetes had ON codes (4%; 4% vs 3%; P for both <.003) but keratopathy was similar among the groups (10%; 9% vs 9%; P=.114, P=.304). Additionally, a similar proportion of patients with type 1 diabetes and those without diabetes had 1 or more code for thyroid eye disease surgery, but surgical rates were lower among those with type 2 diabetes (P <.001).

Investigators noted multiple limitations within their study for clinicians or researchers to consider before overinterpretation of results.

“This study identified thyroid eye disease-related differences in patients with and without diabetes mellitus. Further exploration is warranted, particularly longitudinal analyses of thyroid eye disease presentation and progression in patients with and without diabetes mellitus,” wrote investigators.

This study, “Impact of Diabetes on Thyroid Eye Disease in US Patients: A Claims-Based Study,” was presented at AACE 2021.