Shorts: GLP-1s, biomarkers, and gender affirming surgery
July 18, 2024
A) GLP-1 drugs associated with increased risk of NICU stay
A downside of the phenomenon of more women taking GLP-1 drugs in early pregnancy (see this post from June) is that it appears that “Ozempic babies” may be more likely to spend time in the neonatal ICU, according to a large study from the Epic Research Network, which compiled electronic medical records from 775,000 deliveries. Only about 1100 people (0.15%) were prescribed GLP-1 drugs within 90 days of conception, and it doesn’t appear that the researchers adjusted for BMI, so obesity could have played a role in increased NICU rates. Nonetheless, until there are more safety data, women seeking to conceive should either avoid these medications or take them under the close supervision of their care provider.
B) Ozempic associated with visual disturbance
Researchers at Mass Eye and Ear Infirmary published an observational study in JAMA Ophthalmology earlier this month showing that those on semaglutide for either diabetes or obesity were statistically significantly more likely to get a neuropathy of the eye that can lead to blindness, nonarteritic anterior ischemic optic neuropathy (NAION). NAION visual loss is often permanent, and there is no proven effective treatment. This is a large study, comparing incidence from 194 with diabetes on semaglutide and 254 with obesity on semaglutide to matched controls. Most NAION, if it occurred, took place in the first 12 months of GLP-1 use. Those who take GLP-1 medications and note change in vision should have an ophthalmologic evaluation.
C) Older patients with less education were less likely to get biomarkers to guide cancer therapy
Genetic tests of tumors can help guide oncologists to offer optimal treatment and avoid treatment that is likely to make patients sicker or likely not to help. However, many patients with metastatic colorectal cancer don’t have this testing performed. Researchers reviewed medical records of about 41,000 who were diagnosed with metastatic colorectal cancer from 2010 to 2017. They found that those who were over 50, lived in zip codes with lower rates of high school graduation, and lived in the south were least likely to receive this testing. This research was published in JAMA Network Open on July 5. Employers can ask their carriers to report on biomarker testing a part of their quality assurance process and can be sure that they provide coverage for such testing.
D) Gender affirming surgery is very rare
Researchers from the Harvard Chan School of Public Health reviewed deidentified medical claims from about 47 million adults and 23 million children to ascertain the rate of gender affirming surgery for the year 2019. They identified 85 cases of gender affirming surgery in those under 18, and 82 of these were breast reduction surgery in trans males. Ninety seven percent of all breast reductions performed on minors were performed on cis males. The study was limited to procedures covered by private insurance. This demonstrates that transgender surgery is rarely performed on those under 18.