Epidemiology and Risk Factors of Hyperglycemic Events and Complications Among Patients With Graves' Disease or Thyroid Eye Disease in the United States.

OBJECTIVES

Thyroid eye disease (TED) is a debilitating autoimmune condition frequently associated with Graves' disease (GD). Both disorders may impair glucose metabolism, yet the risk of hyperglycemic events and complications remain unknown. We evaluated the incidence, prevalence, and predictors of these outcomes in patients with TED or GD versus the general population (GP).

METHODS

This retrospective cohort study using the Merative MarketScan Research Claims Database (2014-2019) identified adults (≥18 years) in TED, GD, or GP cohorts via diagnostic codes. The primary outcome was a composite of hyperglycemic events and complications (ie, nephropathy, neuropathy, retinopathy, ketoacidosis, prediabetes, impaired fasting glucose, and hyperosmolarity). Age- and sex-standardized cumulative incidence, incidence (per 10 000 person-years), and prevalence were estimated using 2020 US census data. Kaplan-Meier analyses and multivariable Cox proportional hazards models assessed time-to-event risk, and predictors and hazard ratios, respectively.

RESULTS

The study included 38 723 individuals with TED; 171 831 with GD; and 20 283 009 from the GP. Cumulative incidence of the composite outcome was 14.9% in TED, 15.4% in GD, and 9.6% in GP; incidence was 786.4, 764.4, and 414.0 per 10 000 person-years, respectively. Prevalence was 21.7%, 20.4%, and 11.6%. After adjustment, TED and GD were each associated with a 60% increased risk compared with GP (hazard ratio 1.6). Additional predictors included diabetes, advanced age, obesity, hypertension, and statin use.

CONCLUSIONS

TED and GD are independently associated with elevated risk of hyperglycemic events and complications. Routine metabolic monitoring and multidisciplinary care are warranted in this population.