Noreen Islam1, Rebecca Nash2, Qi Zhang2, Leonidas Panagiotakopoulos1, Tanicia Daley1, Shalender Bhasin3,4, Darios Getahun5,6, J Sonya Haw1, Courtney McCracken7, Michael J Silverberg8, Vin Tangpricha1,9, Suma Vupputuri10, Michael Goodman2. 1. Emory University School of Medicine, Atlanta, GA 30322, USA. 2. Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. 3. Brigham and Women's Hospital, Boston, MA 02115, USA. 4. Harvard School of Medicine, Boston, MA 02115, USA. 5. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, USA. 6. Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA. 7. Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA 30309, USA. 8. Division of Research, Kaiser Permanente, Northern California, Oakland, CA 94612, USA. 9. The Atlanta VA Medical Center, Atlanta, GA 30033, USA. 10. Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, MD 20852, USA.
Abstract
BACKGROUND: Risk of type 2 diabetes mellitus (T2DM) in transgender and gender diverse (TGD) persons, especially those receiving gender-affirming hormone therapy (GAHT) is an area of clinical and research importance. METHODS: We used data from an electronic health record-based cohort study of persons 18 years and older enrolled in 3 integrated health care systems. The cohort included 2869 transfeminine members matched to 28 300 cisgender women and 28 258 cisgender men on age, race/ethnicity, calendar year, and site, and 2133 transmasculine members similarly matched to 20 997 cisgender women and 20 964 cisgender men. Cohort ascertainment spanned 9 years from 2006 through 2014 and follow-up extended through 2016. Data on T2DM incidence and prevalence were analyzed using Cox proportional hazards and logistic regression models, respectively. All analyses controlled for body mass index. RESULTS: Both prevalent and incident T2DM was more common in the transfeminine cohort relative to cisgender female referents with odds ratio and hazard ratio (95% CI) estimates of 1.3 (1.1-1.5) and 1.4 (1.1-1.8), respectively. No significant differences in prevalence or incidence of T2DM were observed across the remaining comparison groups, both overall and in TGD persons with evidence of GAHT receipt. CONCLUSION: Although transfeminine people may be at higher risk for T2DM compared with cisgender females, the corresponding difference relative to cisgender males is not discernable. Moreover, there is little evidence that T2DM occurrence in either transfeminine or transmasculine persons is attributable to GAHT use.
BACKGROUND: Risk of type 2 diabetes mellitus (T2DM) in transgender and gender diverse (TGD) persons, especially those receiving gender-affirming hormone therapy (GAHT) is an area of clinical and research importance. METHODS: We used data from an electronic health record-based cohort study of persons 18 years and older enrolled in 3 integrated health care systems. The cohort included 2869 transfeminine members matched to 28 300 cisgender women and 28 258 cisgender men on age, race/ethnicity, calendar year, and site, and 2133 transmasculine members similarly matched to 20 997 cisgender women and 20 964 cisgender men. Cohort ascertainment spanned 9 years from 2006 through 2014 and follow-up extended through 2016. Data on T2DM incidence and prevalence were analyzed using Cox proportional hazards and logistic regression models, respectively. All analyses controlled for body mass index. RESULTS: Both prevalent and incident T2DM was more common in the transfeminine cohort relative to cisgender female referents with odds ratio and hazard ratio (95% CI) estimates of 1.3 (1.1-1.5) and 1.4 (1.1-1.8), respectively. No significant differences in prevalence or incidence of T2DM were observed across the remaining comparison groups, both overall and in TGD persons with evidence of GAHT receipt. CONCLUSION: Although transfeminine people may be at higher risk for T2DM compared with cisgender females, the corresponding difference relative to cisgender males is not discernable. Moreover, there is little evidence that T2DM occurrence in either transfeminine or transmasculine persons is attributable to GAHT use.
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