PSUN186 Comparison of Thyroid Function Test Screening in Patients with Diabetes Mellitus Type 2 versus Patients with Diabetes Mellitus Type 1

Abstract

Diabetes mellitus (DM) and thyroid dysfunction (TD) are common endocrine diseases that often coexist in clinical practice. Prevalence of TD in individuals with DM type 2 ranges from 9.9 to 48%. There are no screening guidelines for thyroid function in patients with DM type 2 as there are in patients with DM type 1. Our previous electronic medical record (EMR) included an aid that imported diabetes metrics, but the current system does not. A previous study at our institution revealed TSH screening rate to be 86.2% in DM type 1 patients. We examined the rate of screening for TD in patients with DM type 2 versus DM type 1 based on the general population guidelines, and we evaluated the effect of EMR aid versus no aid on screening rate. We also analyzed the underlying etiology of thyroid dysfunction in patients with DM type 2 found to have an abnormal TSH. We compared practice patterns with Centricity (EMR aid; from June 1, 2013 to May 30, 2016) and MedConnect (no EMR aid; from January 1, 2017 to December 31, 2019) in both primary care and endocrinology clinics in the MedStar hospital system in Baltimore, MD. A retrospective review was performed on 949 patient charts (MedConnect 498, Centricity 451). Inclusion criteria were DM type 2 diagnosis (ICD code E 11.0 to E 11.9) and age ≥18 years with at least one outpatient clinic visit. Baseline TSH was done in 551 of overall 949 patients (58.1%), with 249 of 451 (55.2%) in Centricity and 302 of 498 (60.4%) in MedConnect. This difference was not significant (P = 0.5). Of the total 551 patients with baseline TSH, 48 (8.7%) had abnormal TSH, of which 35 patients (11.5%) were in MedConnect and 13 (5.2%) were in Centricity (P = 0.01). Of the overall abnormal results, 35 patients (6.3%) had hypothyroidism, 10 (1.8%) had hyperthyroidism, 2 (0.4%) had subclinical hyperthyroidism, and 1 (0. 2%) had subclinical hypothyroidism results. Logistic regression analysis found that the adjusted odds of baseline TSH screening with endocrinologists was 1.54 times higher than with primary care physicians. No significant difference was found in TSH screening in patients with DM type 2 irrespective of EMR aid. A larger proportion of abnormal results were found in MedConnect than in Centricity. Endocrinologists ordered TSH screening more often than primary care physicians. The screening rate of TSH in patients with DM type 2 was lower than that found in our previous study of TSH screening in patients with DM type 1. This was expected as there are no current screening guidelines for TD specific to DM type 2 patients. Further studies are needed, and consideration should be given to screening all DM type 2 patients with symptoms. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.