Glucose monitors, mpox vaccine inequity and effects of LGBTQ+ restrictions

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

Good morning! If you noticed that the upside down smiley face in yesterday’s newsletter item on the DNC looked absolutely massive compared to the text … no you didn’t.

Are you ready for it? (Continuous glucose monitoring for the masses)

Over the last few decades, continuous glucose monitors — which measure blood glucose using a sensor in the top layer of skin — have changed the entire field of diabetes care. But now, the devices are about to become dramatically more accessible, as two companies prepare to sell them over the counter without a prescription.

Who might be interested? If you ask the companies, the devices could be used by nearly 100 million Americans with prediabetes, people with type 2 diabetes who don’t use insulin, or even healthy people who just want to keep an eye on their blood sugar. One endocrinologist told STAT’s Katie Palmer and Lizzy Lawrence that she expects the “worried well” will be first to start using the new devices.

But could CGMs be misused, or even cause harm? “There’s more questions and buts than there is excitement,” said researcher Susan Schembre. Read more.

How the U.S. could address global vaccine inequity to fight mpox

In early 2022, physician Wilfredo Matias took care of one of the first patients with mpox in Massachusetts. “I remember the deep uncertainty I felt, and the fear in my patient’s eyes as a painful rash spread over their body,” he writes in a First Opinion essay. They were deep in uncharted territory then, with no proven treatments for the disease.

Two years later, there’s a rapidly expanding outbreak of the disease in Central Africa that has led the WHO to declare a public health emergency of international concern. And while we have mpox vaccines now, production scale-up has been disappointing, Matias argues. To address the crisis, he says, the U.S. should commit to sharing at least half of its mpox vaccine stockpile with affected African nations within six months.

“Enhancing global vaccine equity is not just a moral imperative but a strategic investment in our long-term health security,” Matias writes. Read more.

State and school restrictions for LGBTQ+ people are affecting their mental health

Over the past few years, there’s been a major increase in both state bans on gender-affirming care for transgender youth as well as local, school-based restrictions on trans youth participating in sports or using the bathroom that aligns with their gender. Previous research has shown the danger these policies pose for trans youth, but three new studies reaffirm the association between the bans and negative mental health for trans adolescents and adults.

One study in JAMA Network Open, found that out of almost 800 transgender participants ages 18 and older, more than 86% screened positive for symptoms of depression and anxiety. Those who were concerned about their rights being taken away had even higher odds of both.

For young people, the environment at school can play a major role in their mental health. The Trevor Project surveyed 18,000 LGBTQ+ youth ages 13-24 and found that nearly a third of those who were enrolled in school were at an institution with at least one anti-LGTBQ+ policy. Among those at schools with a high number of these policies, 55% reported seriously considering suicide in the past year, compared to 43% of those with fewer and 35% of those at schools with no such policies.

A JAMA Pediatrics study analyzed data from more than 92,000 high school students in Wisconsin. The authors found that trans students report higher risk of anxiety, depression, and considering, planning, or attempting suicide compared to cisgender students. They also report a higher risk of being bullied and of skipping school because they feel unsafe. “Schools serve as sites for both victimization and support for transgender youth,” the authors wrote.

Quantifying the rising toll of heat and extreme weather

Throughout the summer, we’ve been reminding you about the danger that extreme heat can pose to your health. A study published yesterday in JAMA aimed to quantify the burden posed by high temperatures. The researchers found that, between 1999 and 2023 in the U.S., more than 21,500 deaths were recorded with heat as an underlying or contributing cause of death. The annual number of heat-related deaths increased 117% between the years 1999 and 2023.

These could be underestimates, if deaths were misclassified. The perceived increase could also be affected by an increase in awareness about climate change. Regardless, the study authors expect the number of deaths to continue climbing as global temperatures rise.

And while this summer is almost over, heat isn’t the only weather-related risk to our health. Major disaster events — like extreme heat, fires, tornadoes, wind, hurricanes, and storms, but “major” because they result in at least 50 injuries or 10 deaths — account for a disproportionately high number of injuries and deaths. That’s according to another study from yesterday, published in JAMA Network Open, which analyzed data from all storm events between 2006 and 2021. Most major disasters occur in urban areas, but those in rural areas cause about twice as many deaths per event (nine in rural vs. four in urban). Extreme heat and tornadoes constituted almost three-quarters of these major disasters. The data raise concerns about how prepared the U.S. health care system is to respond to major disasters, especially in already under-served rural areas, the authors wrote.

Do clinical trial participants deserve more $$$?

Only about 5% of adults in the U.S. participate in clinical trials. And it’s not a mystery why — the costs of transportation, childcare, meals, the time investment and lost wages are all known barriers to participation. We also already know that financial support from trial sponsors is a good way to address these expenses. So what’s the problem? The confusion lies in the current legal landscape, and the uncertainty around liabilities for both sponsors and participants, according to a First Opinion essay. Read more about the potential roadblocks and how Congress might be able to address them.

What we’re reading

• A Massachusetts town closes its parks to stop a mosquito-borne disease from spreading, NPR

• WHO launches plan to stanch mpox transmission and says the virus can be stopped, STAT
• Blue and red states were putting period products in schools — then came the anti-trans backlash, The 19th
• Dexcom CEO on strategy for bringing continuous glucose monitoring to type 2 diabetes patients, STAT
• Doctors saved her life. She didn’t want them to, New York Times