A link between thyroid eye disease (TED) and diabetes?

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Objective Thyroid eye disease (TED) is a debilitating autoimmune disease characterized by ocular/periorbital tissue inflammation, proptosis, and visual impairment. Known risk factors for TED include radioactive iodine therapy, female sex, and smoking. Risk factors for severe TED include hyperthyroidism, male sex, smoking, and diabetes, but little is known on how diabetes mellitus (DM) influences TED. This claims-based analysis examined TED characteristics in patients with and without diabetes. Methods The Symphony database (2010-2015 US claims) was mined for patients with ≥1 Graves’ disease diagnosis code and ≥1 TED-associated eye code, including proptosis, strabismus, diplopia, lid retraction, exposure keratoconjunctivitis, and optic neuropathy (ON). DM status was determined by type 1/type 2 diabetes coding. Sight-threatening TED was defined as ≥1 optic neuropathy or exposure keratoconjunctivitis code. Results A total of 51,220 patients were identified. Of these, 2618 (5.1%) and 12,846 (25.1%) had type 1 and type 2 DM, respectively. Patients with and without DM were similar, but patients with DM were more often male (type 1: 30.3%, type 2: 28.7% vs. no DM: 20.5%; both p<0.001) and older at first TED code. DM patients had more strabismus (25.4%, 22.6% vs. 19.9%) and diplopia (38.6%, 37.9% vs. 29.9%), but less proptosis (42.3%, 46.3% vs. 58.5%; all p<0.001). Sight-threatening TED occurred more often in DM patients because of higher ON rates. Conclusion TED patients with DM may have more extraocular muscle involvement. Further, higher prevalence of severe TED stemmed from higher optic neuropathy rates, possibly associated with diabetes-related vasculopathies. These hypothesis-generating data justify further exploration.
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