Youth with gender dysphoria may be at increased risk for developing type 1 diabetes, new observational research suggests.

The study of more than 2000 individuals aged 10 to 21 years at a single institution was published online November 22 in Pediatric Diabetes by Santhi N. Logel, MD, and colleagues.

The prevalence of type 1 diabetes among youth with gender dysphoria was a staggering ninefold higher than among those without it.

The prevalence of both type 1 diabetes and youth identifying as transgender, nonbinary, or gender expansive/nonconforming has increased in recent years.

In the United States, type 1 diabetes is estimated to be present in 1.9-2.4 per 1000 population and alternatively gendered youth in about 7 per 1000 population, say Logel, of the division of pediatric endocrinology and diabetes at the School of Medicine and Public Health at University of Wisconsin-Madison, and coauthors.

Yet, "There is no reported association between type 1 diabetes and gender identity in adolescents," write the researchers.

However, a study of adults published in 2017 found a 2.3-fold higher prevalence of type 1 diabetes in patients seen at 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," they say.

The relationship may result from the effects of stress hormones on beta-cell function and/or from increased ascertainment because of more frequent healthcare visits among youth with both type 1 diabetes and gender dysphoria, they speculate.

Support from a healthcare provider is important, the authors emphasize.

In a 2015 survey of transgender individuals, 33% who saw a healthcare provider reported at least one negative experience related to their gender identity and 23% reported avoiding seeing healthcare providers out of fear of mistreatment.

Ninefold Increase in T1D Among Youth With Gender Dysphoria

Of 749,284 patients aged 10-21 years seen at the University of Wisconsin Hospital and Clinics in 2007-2017, in total 2017 were diagnosed with type 1 diabetes, or 2.69 per 1000 population, and 315 were diagnosed with gender dysphoria, or 0.42 per 1000 population.

Both diagnoses were present in eight patients.

The prevalence of type 1 diabetes was 24.77 per 1000 population in the gender dysphoric group compared with 2.68 per 1000 population in the nongender dysphoric group, a highly significant 9.4-fold difference (P < .0001).

Most patients with both conditions were diagnosed with type 1 diabetes prior to presenting at the gender clinic, with average ages of 9.9 and 13 years, respectively (although most report that the feelings of gender dysphoria began earlier).

Of the group with gender dysphoria, three identified as transfeminine, three as transmasculine, one as gender-fluid, and one as gender-neutral. Hormone treatments included gonadotropic-agonist puberty-blocking therapy in four and gender-affirming hormones estrogen in two and testosterone in two.

Glycemic control initially improved after the first gender dysphoria clinic visit over an average of 5 months in five patients, but there were no sustained improvements in A1c.

The finding that glycemic control initially improved but was not sustained "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," Logel and colleagues write.

Known psychiatric diagnoses included anxiety in six, depression in four, and substance abuse in one. Two had suicidal thoughts, and two had attempted suicide by overdosing with insulin.

"To our knowledge, this is the first study in adolescents that shows a possible association between type 1 diabetes and gender dysphoria. Future research will include evaluating biomarkers of stress in adolescents with type 1 diabetes and gender dysphoria and determining the prevalence of gender dysphoria in other chronic autoimmune diseases," the researchers conclude.

Pediatr Diabetes. Published online November 22, 2019. Abstract

For more diabetes and endocrinology news, follow us on Twitter and on Facebook.