Introduction and Objective: Transgender, non-binary, and genderqueer people experience systematic barriers in receipt of medical care. Our objective was to understand patterns of diabetes treatment/outcomes for this population.Methods: Patients with an ICD code diagnosis of T2DM between 01/01/2021 and 01/13/2024 in nationwide Epic EHR data were included and A1c control, receipt of antidiabetic medication classes, and rates of diabetes complications were analyzed by self-reported gender identity.Results: A total of 4,689,434 were newly diagnosed with T2DM. Among those who provided gender identity, 6,325 (0.4%) were of a gender minority group. Gender minority patients tended to have higher A1c at diagnosis (Figure 1). Compared to cisgender female patients, transgender male and transgender female patients were less likely to have A1c <7% (OR 0.75, 95% CI 0.70-0.81 and OR 0.73, 95% CI 0.69-0.77) and more likely to receive insulin (OR 1.18, 95% CI 1.10-1.28 and OR 1.25, 95% CI 1.17-1.33). Transgender male patients were less likely to receive TZDs, DPP4i, or SGLT2i. Transgender male and transgender female patients were more likely to have ketoacidosis (OR 2.94, 95% CI 2.50-3.45 and OR 2.63, 95% CI 2.27-3.05), and transgender female patients were more likely to have diabetic foot ulcers (OR 2.06, 95% CI 1.71-2.48) and lower limb amputations.Conclusion: Greater attention to diabetes care is needed to promote health equity for gender minority patients.
J.B. Lusk: None. F. Li: None. E. OBrien: Research Support; Pfizer Inc. S. Aymes: None.
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