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Bulum T, Vučić Lovrenčić M, Knežević Ćuća J, Tomić M, Vučković-Rebrina S, Duvnjak L. Relationship between β-Cell Autoantibodies and Their Combination with Anthropometric and Metabolic Components and Microvascular Complications in Latent Autoimmune Diabetes in Adults. Biomedicines 2023; 11:2561. [PMID: 37761002 PMCID: PMC10526032 DOI: 10.3390/biomedicines11092561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS Our study aimed to investigate the relationship between three autoantibodies and their combination with anthropometric and metabolic components and microvascular complications in patients with latent autoimmune diabetes in adults (LADA). METHODS Our study included 189 LADA patients divided into four subgroups according to the autoantibodies present: glutamic acid decarboxylase autoantibodies (GADA) only; zinc transporter-8 autoantibodies (ZnT8A)+GADA; insulinoma-associated-2 autoantibodies (IA-2)+GADA; and ZnT8+IA-2+GADA. RESULTS Compared to GADA positivity only, patients with ZnT8+GADA positivity and ZnT8+IA-2+GADA positivity had a shorter diabetes duration and lower body mass index (BMI); patients with ZnT8+GADA positivity were younger and showed an increase in glomerular filtration rate, while those with ZnT8+IA-2+GADA positivity had lower C-peptide and lower insulin resistance measured with HOMA2-IR. In a multiple regression analysis, ZnT8 positivity was associated with lower BMI (p = 0.0024), female sex (p = 0.0005), and shorter duration of disease (p = 0.0034), while IA-2 positivity was associated with lower C-peptide levels (p = 0.0034) and shorter diabetes duration (p = 0.02). No association between antibody positivity and microvascular complications of diabetes, including retinopathy, neuropathy, and microalbuminuria, as well as with variables of glucose control and β-cell function were found. CONCLUSION The results of our study suggest that ZnT8 and IA-2 autoantibodies are present in a significant number of LADA patients and associated with clinical and metabolic characteristics resembling classic type 1 diabetes. Due to increased LADA prevalence, earlier identification of patients requiring frequent monitoring with the earlier intensification of insulin therapy might be of special clinical interest.
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Affiliation(s)
- Tomislav Bulum
- Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- Medical School, University of Zagreb, 10000 Zagreb, Croatia
| | - Marijana Vučić Lovrenčić
- Clinical Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
- Scientific Research Unit, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Jadranka Knežević Ćuća
- Clinical Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Sandra Vučković-Rebrina
- Department of Neurology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Lea Duvnjak
- Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- Medical School, University of Zagreb, 10000 Zagreb, Croatia
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Kawasaki E. Anti-Islet Autoantibodies in Type 1 Diabetes. Int J Mol Sci 2023; 24:10012. [PMID: 37373160 DOI: 10.3390/ijms241210012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Anti-islet autoantibodies serve as key markers in immune-mediated type 1 diabetes (T1D) and slowly progressive T1D (SPIDDM), also known as latent autoimmune diabetes in adults (LADA). Autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA), tyrosine phosphatase-like protein IA-2 (IA-2A), and zinc transporter 8 (ZnT8A) are currently employed in the diagnosis, pathological analysis, and prediction of T1D. GADA can also be detected in non-diabetic patients with autoimmune diseases other than T1D and may not necessarily reflect insulitis. Conversely, IA-2A and ZnT8A serve as surrogate markers of pancreatic β-cell destruction. A combinatorial analysis of these four anti-islet autoantibodies demonstrated that 93-96% of acute-onset T1D and SPIDDM cases were diagnosed as immune-mediated T1D, while the majority of fulminant T1D cases were autoantibody-negative. Evaluating the epitopes and immunoglobulin subclasses of anti-islet autoantibodies help distinguish between diabetes-associated and non-diabetes-associated autoantibodies and is valuable for predicting future insulin deficiency in SPIDDM (LADA) patients. Additionally, GADA in T1D patients with autoimmune thyroid disease reveals the polyclonal expansion of autoantibody epitopes and immunoglobulin subclasses. Recent advancements in anti-islet autoantibody assays include nonradioactive fluid-phase assays and the simultaneous determination of multiple biochemically defined autoantibodies. Developing a high-throughput assay for detecting epitope-specific or immunoglobulin isotype-specific autoantibodies will facilitate a more accurate diagnosis and prediction of autoimmune disorders. The aim of this review is to summarize what is known about the clinical significance of anti-islet autoantibodies in the pathogenesis and diagnosis of T1D.
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Affiliation(s)
- Eiji Kawasaki
- Diabetes Center, Shin-Koga Hospital, Kurume 830-8577, Japan
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Alam A, Singh SK, Kumar R. Prevalence of Organ-Specific Autoimmunity in Patients With Type 1 Diabetes Mellitus. Cureus 2023; 15:e38855. [PMID: 37303388 PMCID: PMC10256565 DOI: 10.7759/cureus.38855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is associated with other autoimmune disorders that are characterized by presence of organ-specific autoantibodies. The present study was undertaken to assess the prevalence of organ-specific autoantibodies among newly diagnosed T1DM subjects of India and to study its relationship with glutamic acid decarboxylase antibody (GADA). We also compared the clinical and biochemical parameters in GADA-positive and -negative T1DM subjects. METHODS In a hospital-based cross-sectional study, we studied 61 patients with newly diagnosed T1DM ≤ 30 years of age. T1DM was diagnosed on the basis of acute onset of osmotic symptoms with or without ketoacidosis, severe hyperglycaemia [blood glucose > 13.9 mmol/l (>250 mg/dl)] and insulin requirement from the onset of diabetes. Subjects were screened for autoimmune thyroid disease (thyroid peroxidase antibody [TPOAb]), celiac disease (tissue transglutaminase antibody [tTGAb]), and gastric autoimmunity (parietal cell antibody [PCA]). RESULTS Of the 61 subjects, more than one-third (38%) had at least one positive organ-specific autoantibody. In particular, 13 (21.3%) were found to be positive for TPOAb, nine (14.8%) were positive for tTGAb and 11 (18%) were positive for PCA. GADA was positive in 15 (25%) subjects. The frequency of TPOAb tended to be higher in patients who had GADA positivity compared with those with no circulating GADA (40% vs. 15.2%; p=0.07). Subjects positive for GADA were also more likely to be PCA positive compared with those who were GADA negative (40 vs.10.9%, p=0.02). There were no differences in frequency of diabetic ketoacidosis, body mass index, hemoglobin A1C (HbA1c), insulin requirement or fasting C-peptide in GADA-positive and -negative patients. CONCLUSION We support the recommendation for regular screening of organ-specific autoantibodies, in particular TPOAb, tTGAb and PCA in all patients with T1DM. Detection of these autoantibodies at onset may prevent complications associated with delayed diagnosis of these disorders. We also conclude that there is higher frequency of TPOAb and PCA in GADA-positive T1DM patients as compared to negative ones. However, patients with positive GADA had similar clinical and biochemical parameters compared to GADA-negative subjects. Lastly, low GADA positivity in our study cohort as compared to Western populations suggests the heterogenous nature of T1DM in the Indian population.
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Affiliation(s)
- Ahmad Alam
- Endocrinology, Diabetes and Metabolism, Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College Hospital (JNMCH) Aligarh Muslim University, Aligarh, IND
- Endocrinology, Diabetes and Metabolism, Department of Endocrinology and Metabolism, Institute of Medical Sciences (IMS) Banaras Hindu University, Varanasi, IND
| | - Surya K Singh
- Endocrinology, Diabetes and Metabolism, Department of Endocrinology and Metabolism, Institute of Medical Sciences (IMS) Banaras Hindu University, Varanasi, IND
| | - Ritesh Kumar
- Endocrinology, Diabetes and Metabolism, Department of Endocrinology and Metabolism, Institute of Medical Sciences (IMS) Banaras Hindu University, Varanasi, IND
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Wang LT, Huang CY, Lin CH, Cheng BW, Lo FS, Ting WH, Lee YJ. Graves disease is more prevalent than Hashimoto disease in children and adolescents with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 13:1083690. [PMID: 36704033 PMCID: PMC9871454 DOI: 10.3389/fendo.2022.1083690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Autoimmune thyroid disease (AITD) is the most common associated autoimmune disorder in type 1 diabetes (T1D). Early detection of AITD is crucial to optimize glycemic control, growth, and intellectual development. In this prospective cohort study, we sought to characterize the prevalence, incident ages and risk factors of AITD in children and adolescents with T1D. Materials and methods Patients with T1D diagnosed at ≤ 18 years at MacKay Children's Hospital, Taipei, from 1990 to 2019 underwent annual screening for AITD. Institutional Review Board-approved data on age, sex, and disease profile are collected. Statistical analysis was performed by using independent sample t test for continuous variables, chi-squared test for categorical variables, and Kaplan-Meier estimates of cumulative incidence of AITD were calculated. A p value of <0.05 was considered statistically significant. Results We prospectively followed up 808 patients with T1D, 761 patients were included in the study. Of these patients, 197 (25.9%) of them had thyroid autoimmunity, meaning positivity of thyroid autoantibodies. Females had a higher prevalence of thyroid autoimmunity than males (59.9%, p = 0.012). Altogether, 5.5% patients developed AITD (4.1% had Graves disease; 1.4% had Hashimoto disease), at a mean age of 17.8 ± 8.5 years. The cumulative incidence of AITD at 30 years of disease duration was 0.29 in the total group and was significantly higher in females (0.39, n = 397) than in males (0.15, n = 364, p<0.001). Discussion In Taiwan, the prevalence of AITD in pediatric population with T1D increases with age, a longer disease duration and female sex. For early detection of autoimmune thyroid disease in Taiwanese children and adolescents with T1D, an annual AITD screening program should be implemented.
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Affiliation(s)
- Lu-Ting Wang
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
| | - Chi-Yu Huang
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
| | - Chao-Hsu Lin
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Bi-Wen Cheng
- Department of Pediatric Endocrinology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Fu-Sung Lo
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsin Ting
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yann-Jinn Lee
- Department of Pediatric Endocrinology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Medical Research, Tamsui MacKay Memorial Hospital, New Taipei City, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Roldán Martín MB, Márquez Romero C, Guerra Vilches E, Ruiz Usabiaga J, Barrio Castellanos R, Martín Frías M, Plaza Oliver D, Camarero Salces C. Celiac disease screening in children and adolescents with type 1 diabetes mellitus: What test should be performed? ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:153-158. [PMID: 34167694 DOI: 10.1016/j.endien.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/06/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Children and adolescents with type 1 diabetes mellitus (T1DM) are at high risk for the development of celiac disease (CD) because of the common genetic characteristics of both conditions. The study objectives were to investigate the frequency of the human leukocyte antigen system (HLA) for CD in pediatric T1DM patients and to determine whether HLA testing is suitable for CD screening in that population and is cost-effective as compared to serological screening for CD. PATIENTS AND METHODS A retrospective, descriptive study was conducted in 296 patients (148 girls; 148 boys) with T1DM aged <18 years who attended a Madrid hospital. Data on the frequency of genotypes DQ2/DQ8 in a subgroup of 92 patients and the additional cost of performing HLA typing for screening CD were collected. Only when the risk HLA haplotype (DQ2/DQ8) is negative no further serological screening for CD is required. RESULTS Twenty-three patients with T1DM (7.77%) also had CD. Alleles DQ2 or DQ8 were found in 91.3% of patients in whom the HLA haplotype was studied. Thus, only 8.7% with a negative haplotype would have benefited from HLA testing. The additional cost of HLA typing was € 105.2 for each patient with positive DQ2 or DQ8 in our population. CONCLUSIONS HLA typing is not a cost-effective screening method for CD in T1DM because of the frequent association of T1DM with risk genotypes for CD.
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Affiliation(s)
- M Belén Roldán Martín
- Unidad de Endocrinología y Diabetes, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain.
| | | | | | - Juan Ruiz Usabiaga
- Servicio de Atención al Paciente, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Raquel Barrio Castellanos
- Unidad de Endocrinología y Diabetes, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Martín Frías
- Unidad de Endocrinología y Diabetes, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - David Plaza Oliver
- Servicio de Pediatría, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Cristina Camarero Salces
- Unidad de Gastroenterología, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
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Unal E, Demiral M, Baysal B, Ağın M, Devecioğlu EG, Demirbilek H, Özbek MN. Frequency of Celiac Disease and Spontaneous Normalization Rate of Celiac Serology in Children and Adolescent Patients with Type 1 Diabetes. J Clin Res Pediatr Endocrinol 2021; 13:72-79. [PMID: 32820875 PMCID: PMC7947719 DOI: 10.4274/jcrpe.galenos.2020.2020.0108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The prevalence of celiac disease (CD) varies between 1% and 10% in patients with type 1 diabetes mellitus (T1DM). This study aimed to determine the frequency of spontaneous recovery of celiac serology and the biopsy-proven CD (BPCD) frequency in patients with T1DM. METHODS The data of 668 patients with available celiac serology tests from a total of 779 patients who were followed for the last 10 years with the diagnosis of T1DM were retrospectively evaluated. RESULTS Positive serology was detected in 103 out of 668 (15.4%) patients. There was spontaneous normalization in 24 (23.3%), fluctuation in 11 (10.7%) and permanently positive serology in 68 (66%). In 46 out of 53 (86.8%) patients with positive serology and biopsy, CD diagnosis was confirmed by biopsy (BPCD). The frequency of BPCD was 6.9%, and the serology in 76.1% was positive at the time of diagnosis of T1DM. The weight, height and body mass index-standard deviation score at diagnosis were lower in patients with BPCD compared to the group without CD. An anti-tissue transglutaminase-IgA (anti-TTG-IgA) level of 11.8 times the upper limit of normal was the most sensitive (93%) and specific (90%) cut-off for BPCD (area under the curve: 0.95; 95% confidence interval: 0.912-1; p<0.001). CONCLUSION In our cohort, the frequency of positive serology for CD was 15.4%, while the rate of BPCD was 6.9%. The majority (97.8%) of cases were diagnosed within the first five years of T1DM. In 23.3% of cases, positive anti-TTG-IgA spontaneously resolved without a gluten-free diet (GFD). Therefore, serological follow-up instead of immediate duodenal biopsy or GFD therapy, particularly for patients with asymptomatic and mild anti-TTG IgA level, is warranted.
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Affiliation(s)
- Edip Unal
- Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey,* Address for Correspondence: Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey Phone: +90 412 248 80 01 E-mail:
| | - Meliha Demiral
- Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yaşargil Training and Research Hospital, Clinic of Paediatrics, Diyarbakır, Turkey
| | - Mehmet Ağın
- Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Gastroenterology, Diyarbakır, Turkey
| | - Elif Gökçe Devecioğlu
- Gazi Yaşargil Training and Research Hospital, Clinic of Pathology, Diyarbakır, Turkey
| | - Hüseyin Demirbilek
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
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Roldán Martín MB, Márquez Romero C, Guerra Vilches E, Ruiz Usabiaga J, Barrio Castellanos R, Martín Frías M, Plaza Oliver D, Camarero Salces C. Cribado de enfermedad celiaca en niños y adolescentes con diabetes mellitus tipo 1: ¿qué estrategia utilizar? ENDOCRINOL DIAB NUTR 2021; 68:153-158. [DOI: 10.1016/j.endinu.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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Longo M, Cirillo P, Scappaticcio L, Tomasuolo M, Pernice V, Caruso P, Bellastella G, Maiorino MI, Esposito K. Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases. J Sex Med 2020; 18:219-223. [PMID: 33223430 DOI: 10.1016/j.jsxm.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/03/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Female sexual dysfunctions (FSDs) are frequent concerns in women with type 1 diabetes (T1D), which is frequently associated with other autoimmune diseases (ADs). AIM To assess sexual function in young type 1 diabetic women with or without additional ADs. METHODS Women with T1D aged 18-35 years with a stable couple relationship and no oral contraceptive use were enrolled. Diabetic women with concomitant ADs were also identified. All women completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale. OUTCOMES The main outcome was the prevalence of FSD. The FSFI-single domain scores were also evaluated in diabetic women with or without additional ADs. RESULTS The global population included 154 diabetic women, of whom 66 (42%) had at least one additional AD. The prevalence of FSD was similar among diabetic women with and those without (30% vs 32%, P = .980) additional ADs. The FSFI-desire score was significantly lower among diabetic women with concomitant ADs than those without ADs [median (interquartile range), 4.1 (3.6, 4.8) vs 4.6 (4.0, 5.0), P = .042]. CLINICAL IMPLICATIONS An early evaluation of sexual function in women with T1D and concomitant ADs should be encouraged. STRENGTHS & LIMITATIONS Major strengths are the use of 2 validated tools to diagnose FSD and the relatively large number of subjects investigated. The limitations include the cross-sectional nature of the study, which does not allow to make inference regarding the cause and effect. CONCLUSION Diabetic women with additional ADs show an impairment in sexual desire as compared with those suffering only from diabetes. Longo M, Cirillo P, Scappaticcio L, et al. Female Sexual Function in Young Women With Type 1 Diabetes and Additional Autoimmune Diseases. J Sex Med 2021;18:219-223.
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Affiliation(s)
- Miriam Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lorenzo Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Tomasuolo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vlenia Pernice
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Caruso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Unit of Diabetes, University of Campania "Luigi Vanvitelli", Naples, Italy
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Gardner JA, Johnson RK, Dong F, Hoffman M, Steck AK, Frohnert BI, Rewers M, Norris JM. Gluten intake and risk of thyroid peroxidase autoantibodies in the Diabetes Autoimmunity Study In the Young (DAISY). Endocrine 2020; 70:331-337. [PMID: 32651851 PMCID: PMC7584755 DOI: 10.1007/s12020-020-02412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Autoimmune diseases co-occur, perhaps due to common risk factors. The age at gluten introduction and gluten intake in early childhood has been associated with the autoimmunity preceding celiac disease (CD) and type-1 diabetes (T1D). We explored their associations with the development of thyroid autoimmunity. METHODS DAISY has prospectively followed children at increased risk for T1D and CD since 1993. During follow-up, 107 children developed thyroid autoimmunity, defined as positivity for autoantibodies against thyroid peroxidase on at least two study visits. Age at gluten introduction was ascertained from food history interviews every 3 months until 15 months of age. Gluten intake (g/day) at age 1-2 years was estimated using a food frequency questionnaire. RESULTS From multivariable Cox regression, there was no association between the age of gluten introduction nor the amount of gluten intake and development of thyroid autoimmunity. However, females (hazard ratio = 2.19, 95% CI: 1.46, 3.27) and cases of islet autoimmunity (HR = 2.20, 95% CI: 1.39, 3.50) were significantly more likely to develop thyroid autoimmunity, while exposure to environmental tobacco smoke decreased the risk (HR = 0.46, 95% CI: 0.30, 0.71). CONCLUSIONS Neither the age of gluten introduction nor the amount of gluten consumed in early childhood is associated with risk of thyroid autoimmunity.
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Affiliation(s)
| | - Randi K Johnson
- Division of Bioinformatics and Personalized Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Fran Dong
- Barbara Davis Center for Diabetes, Aurora, CO, USA
| | | | | | | | | | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
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Agarwal N, Dave C, Patel R, Shukla R, Bajpai A. Celiac Disease in Indian Children and Adolescents with Type 1 Diabetes. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1923-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Autoimmune Thyroid Disease is Associated with a Lower Prevalence of Diabetic Retinopathy in Patients with Type 1 Diabetic Mellitus. Medicina (B Aires) 2020; 56:medicina56060255. [PMID: 32466561 PMCID: PMC7353863 DOI: 10.3390/medicina56060255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022] Open
Abstract
Background and objectives: The aim of the study was to assess the correlation of autoimmune thyroid diseases (AITD) in patients with diabetes mellitus type 1 (DM1) with the occurrence of diabetic retinopathy (DR). Materials and Methods: The inclusion criteria for the study were: type 1 diabetes diagnosed on the basis of WHO criteria lasting at least a year, presence of AITD for at least a year, and age over 18 years. The control group consisted of patients without diagnosed AITD (DM1noAITD), selected according to age, BMI and DM1 duration. Anthropometric parameters, metabolic risk factors such as glycated hemoglobin (HbA1c), lipids and blood pressure, thyroid status and the presence of DR were assessed. Results: The study involved 200 patients with type 1 diabetes aged 36 ± 12 years, 70 men and 130 women. Patients from the study group (DM1AITD) had significantly lower creatinine concentration, significantly lower systolic blood pressure (SBP), glycated hemoglobin (HbA1c) percentage and triglyceride (TG) concentration, and higher high-density lipoprotein (HDL-cholesterol) concentration than the control group (DM1noAITD). There was a significantly lower chance of non-proliferative diabetic retinopathy (NPDR) among DM1AITD than in the control group. Conclusions: Patients with DM1 and AITD were metabolically better balanced, as evidenced by a significantly lower SBP, percentage of HbA1c and TG, as well as significantly higher HDL-cholesterol in this group. Patients with DM1 and AITD were significantly less likely to have NPDR than the control group.
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Mäkimattila S, Harjutsalo V, Forsblom C, Groop PH. Every Fifth Individual With Type 1 Diabetes Suffers From an Additional Autoimmune Disease: A Finnish Nationwide Study. Diabetes Care 2020; 43:1041-1047. [PMID: 32139386 DOI: 10.2337/dc19-2429] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to quantify the excess risk of autoimmune hypothyroidism and hyperthyroidism, Addison disease, celiac disease, and atrophic gastritis in adults with type 1 diabetes (T1D) compared with nondiabetic individuals in Finland. RESEARCH DESIGN AND METHODS The study included 4,758 individuals with T1D from the Finnish Diabetic Nephropathy (FinnDiane) Study and 12,710 nondiabetic control individuals. The autoimmune diseases (ADs) were identified by linking the data with the Finnish nationwide health registries from 1970 to 2015. RESULTS The median age of the FinnDiane individuals at the end of follow-up in 2015 was 51.4 (interquartile range 42.6-60.1) years, and the median duration of diabetes was 35.5 (26.5-44.0) years. Of individuals with T1D, 22.8% had at least one additional AD, which included 31.6% of women and 14.9% of men. The odds ratios for hypothyroidism, hyperthyroidism, celiac disease, Addison disease, and atrophic gastritis were 3.43 (95% CI 3.09-3.81), 2.98 (2.27-3.90), 4.64 (3.71-5.81), 24.13 (5.60-104.03), and 5.08 (3.15-8.18), respectively, in the individuals with T1D compared with the control individuals. The corresponding ORs for women compared with men were 2.96 (2.53-3.47), 2.83 (1.87-4.28), 1.52 (1.15-2.02), 2.22 (0.83-5.91), and 1.36 (0.77-2.39), respectively, in individuals with T1D. Late onset of T1D and aging increased the risk of hypothyroidism, whereas young age at onset of T1D increased the risk of celiac disease. CONCLUSIONS This is one of the largest studies quantifying the risk of coexisting AD in adult individuals with T1D in the country with the highest incidence of T1D in the world. The results highlight the importance of continuous screening for other ADs in individuals with T1D.
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Affiliation(s)
- Sari Mäkimattila
- Endocrinology and Diabetes, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Nephrology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Nephrology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
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Odeh R, Alassaf A, Gharaibeh L, Ibrahim S, Khdair Ahmad F, Ajlouni K. Prevalence of celiac disease and celiac-related antibody status in pediatric patients with type 1 diabetes in Jordan. Endocr Connect 2019; 8:780-787. [PMID: 31085767 PMCID: PMC6590199 DOI: 10.1530/ec-19-0146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Scientific findings regarding the prevalence of celiac disease (CD) in pediatric patients with type 1 diabetes (T1D) in the Arab world are scarce. We aimed to determine the prevalence of biopsy-proven celiac disease (BPCD) among pediatric patients with T1D from Jordan. We also assessed the possible predictors for developing CD in this cohort of patients and we compared T1D patients who developed BPCD with those who had positive CD serology but negative histology and/or fluctuating CD serology. METHODS Celiac serology and duodenal biopsy results from 2012 to 2017 were collected from patients with T1D. The outcome of positive celiac serology and the risk factors for CD in T1D patients were investigated. RESULTS A total of 538 children of which 278 boys (51.7%) were included in the study. The prevalence of positive serology and the diagnosis of BPCD in this cohort of T1D patients were 16.6 and 9.1% respectively. Eighty percent of those with BPCD were asymptomatic and 47% were diagnosed with CD at onset of T1D. Spontaneous normalization of celiac serology occurred in 23.6% of those with positive serology. CONCLUSION CD is prevalent in T1D pediatric patients from Jordan (9.1%). It is often asymptomatic and the majority of cases were diagnosed at onset or within 5 years of T1D diagnosis. Spontaneous normalization of CD serology occurred in some patients with T1D. Hence, a watchful follow-up is recommended in such patients.
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Affiliation(s)
- Rasha Odeh
- Section of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
- Correspondence should be addressed to R Odeh:
| | - Abeer Alassaf
- Section of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | | | - Sarah Ibrahim
- Section of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Fareed Khdair Ahmad
- Section of Pediatric Gastroenterology, Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman, Jordan
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Rydzewska M, Michalak J, Bossowska A, Chen S, Black S, Powell M, Furmaniak J, Rees Smith B, Bossowski A. Analysis of diabetes-associated autoantibodies in children and adolescents with autoimmune thyroid diseases. J Pediatr Endocrinol Metab 2019; 32:355-361. [PMID: 30903759 DOI: 10.1515/jpem-2018-0367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 02/08/2019] [Indexed: 01/08/2023]
Abstract
Background Zinc transporter 8 autoantibodies (ZnT8Abs) together with glutamic acid decarboxylase autoantibodies (GADAbs), insulinoma antigen 2 autoantibodies (IA-2Abs) and insulin autoantibodies (IAbs) are markers of type 1 diabetes mellitus (T1DM). We studied the prevalence of ZnT8Ab in children with autoimmune thyroid diseases (AITDs) to assess the association of AITDs and T1DM at the serological level. Methods The study groups consisted of 44 children with Graves' disease (GD), 65 children with Hashimoto's thyroiditis (HT), 199 children with T1DM with or without AITDs and 58 control children. ZnT8Ab, GADAb, IA-2Ab, IAb, 21-hydroxylase autoantibodies (21-OHAbs) and acetylcholine receptor autoantibodies (AChRAbs) were measured. Results ZnT8Abs were found in 4/44 (9.1%) patients with GD, and 4/44 (9.1%) patients with GD were positive for GADAb. Of the 65 HT patients, six (9.2%) were positive for ZnT8Ab, while four (6.2%) were positive for GADAb. In the T1DM group, 128/199 (64%) of the patients were positive for ZnT8Ab, 133/199 (67%) for GADAb and 109/199 (55%) for IA-2Ab. One GD patient and one HT patient were positive for all the four diabetes-associated autoantibodies. Two HT patients were positive for three diabetes autoantibodies. Two GD (4.5%) and five HT (7.7%) patients were positive for 21-OHAb only. None of the patients had AChRAb. In the control group, 2/58 (3.4%) were positive for GADAb and 2/58 (3.4%) were positive for ZnT8Ab. Conclusions Diabetes-associated autoantibodies including ZnT8Ab were found in children and adolescents with GD and HT.
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Affiliation(s)
- Marta Rydzewska
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Justyna Michalak
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Anna Bossowska
- Division of Cardiology, Internal Affairs Ministry Hospital in Białystok, Białystok, Poland
| | - Shu Chen
- FIRS Laboratories, RSR Ltd, Cardiff, UK
| | | | | | | | | | - Artur Bossowski
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University of Białystok, ul. Waszyngtona 17, Białystok 15-274, Poland
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Human Leukocyte Antigen class II polymorphisms among Croatian patients with type 1 diabetes and autoimmune polyglandular syndrome type 3 variant. Gene 2018; 674:93-97. [DOI: 10.1016/j.gene.2018.06.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/06/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
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17
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Mahmud FH, Elbarbary NS, Fröhlich-Reiterer E, Holl RW, Kordonouri O, Knip M, Simmons K, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:275-286. [PMID: 30066458 PMCID: PMC6748835 DOI: 10.1111/pedi.12740] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Farid H. Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Mikael Knip
- Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado
| | - Maria E. Craig
- The Children’s Hospital at Westmead, Westmead, NSW, Australia,Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia,School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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Wherrett DK, Ho J, Huot C, Legault L, Nakhla M, Rosolowsky E. Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S234-S246. [DOI: 10.1016/j.jcjd.2017.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Singh P, Seth A, Kumar P, Sajjan S. Coexistence of celiac disease & type 1 diabetes mellitus in children. Indian J Med Res 2018; 145:28-32. [PMID: 28574011 PMCID: PMC5460569 DOI: 10.4103/ijmr.ijmr_199_15] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND & OBJECTIVES Type 1 diabetes mellitus (T1DM) and celiac disease (CD) tend to co-exist due to similar underlying genetic predisposition. Failure to recognize CD in patients with T1DM predisposes them to complications. The present study was aimed to assess children with T1DM for the presence of CD. METHODS This was a retrospective analysis of the records of children with T1DM attending paediatric endocrinology clinic at a tertiary care hospital in north India from January 2006 to May 2014. All children were screened for CD at the time of diagnosis of T1DM using IgA anti-tissue transglutaminase (anti-tTG) levels in serum. Seropositive children were subjected to upper gastrointestinal endoscopy and duodenal biopsy for histopathological confirmation. The children also underwent thyroid function testing (TFT); those with deranged TFT were evaluated for thyroid-specific antibodies. RESULTS Positive serology for CD was present in 43 of 126 children with T1DM whose records were reviewed [34.1%; 95% confidence interval (CI): 25.9-43.1]. Confirmed CD was diagnosed in 17 (13.5%; CI: 8.1-20.7) of the children screened and 17 of 40 (42.5%; CI: 27.1-59.1) seropositive participants. Four out of 17 children with coexisting CD and T1DM also had autoimmune thyroiditis with overt hypothyroidism. The children with confirmed CD were more likely to have short stature [odds ratios (OR)-3.16; 95% CI: 1.09-9.20, P<0.05] and hypothyroidism (OR-6.4; 95% CI: 1.52-26.90, P<0.05). INTERPRETATION & CONCLUSIONS Our study showed a higher proportion of CD in children with T1DM as compared to that reported in general population. Regular screening of children with T1DM for CD is needed to improve metabolic control and prevent long-term complications.
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Affiliation(s)
- Preeti Singh
- Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Anju Seth
- Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Sushma Sajjan
- Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
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Spaans E, Schroor E, Groenier K, Bilo H, Kleefstra N, Brand P. Thyroid Disease and Type 1 Diabetes in Dutch Children: A Nationwide Study (Young Dudes-3). J Pediatr 2017; 187:189-193.e1. [PMID: 28583704 DOI: 10.1016/j.jpeds.2017.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/28/2017] [Accepted: 05/03/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the prevalence of overt thyroid disease in children in The Netherlands with and without type 1 diabetes mellitus (T1DM). STUDY DESIGN Nationwide, retrospective cohort study in The Netherlands. Using the national registry of both healthcare reimbursement and pharmaceutical care, data of all Dutch children (aged 0-14 years) with a diagnosis of T1DM, or a diagnosis of hypothyroidism or hyperthyroidism in the period 2009-2011. RESULTS The prevalence of thyroid disease was 0.15% in children without T1DM, and 3.43% in children with T1DM (rate ratio 23.59; 95% CI 19.92-27.93; P < .001). Both hyperthyroidism and hypothyroidism were 24 times more likely in children with T1DM than in those without. Thyroid disease was more common in girls than in boys, both in children with T1DM (rate ratio of girls vs boys 3.07; 95% CI 2.10-4.49) and in children without T1DM (rate ratio 1.59; 95% CI 1.49-1.69). This sex difference was more pronounced for hypothyroidism than for hyperthyroidism. CONCLUSIONS Children with T1DM in The Netherlands are 24 times more likely to develop thyroid disease than their peers without diabetes. Girls with T1DM were more prone to thyroid disease, particularly hypothyroidism.
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Affiliation(s)
- Engelina Spaans
- Diabetes Centre, Isala, Zwolle, The Netherlands; Princess Amalia Children's Centre, Isala, Zwolle, The Netherlands.
| | - Eelco Schroor
- Princess Amalia Children's Centre, Isala, Zwolle, The Netherlands
| | - Klaas Groenier
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Nanne Kleefstra
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Langerhans Medical Research Group, Zwolle, The Netherlands
| | - Paul Brand
- Princess Amalia Children's Centre, Isala, Zwolle, The Netherlands; University Medical Center and University of Groningen Postgraduate School of Medicine, University Medical Center and University of Groningen, The Netherlands
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Zou C, Jiao Y, Li X, Wang P, Zheng J, Zhao Y, Boodhun D, Hu Z, Zheng C. Differences between healthy adults and patients with type 2 diabetes mellitus in reactivity of toe microcirculation by ultrasound combined with a warm bath test. Medicine (Baltimore) 2017; 96:e7035. [PMID: 28562559 PMCID: PMC5459724 DOI: 10.1097/md.0000000000007035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to explore the feasibility and clinical value of ultrasound combined with a warm bath test in assessing the differences in reactivity of toe microcirculation between healthy adults and patients with type 2 diabetes mellitus (T2DM).A total of 56 T2DM patients were recruited as case group, whereas 50 healthy volunteers were enrolled as control group.Fasting blood glucose, glycated hemoglobin, total cholesterol, triglyceride, low-density lipoprotein cholesterol in T2DM group were significantly higher than in control group. Under stationary condition, peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV) were lower, but pulsatility index (PI) and resistance index (RI) were higher in patients with T2DM than in controls both in dorsalis pedis artery (DPA) and plantar digital artery (PDA). On response to the warm test, PSV, EDV, and MV increased and PI and RI decreased both in DPA and PDA in these 2 groups. Moreover, the change rate in PSV, EDV, MV, PI, and RI of PDA was significantly lower in T2DM group than in control group.Color Doppler combined with a warm bath test may be used as a new method in evaluating the differences in reactivity of distal limb microvascular between healthy adults and patients with T2DM.
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Affiliation(s)
- Chunpeng Zou
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Yan Jiao
- Obstetrics and Gynecology Ultrasonic Department, Wenzhou City Peoples’ Hospital, Wenzhou
| | - Xiuyun Li
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Ping Wang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Jinjue Zheng
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Yaping Zhao
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | | | - Zhen Hu
- Department of Chinese and Western Integrative Medicine
| | - Chao Zheng
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Jonsdottir B, Larsson C, Carlsson A, Forsander G, Ivarsson SA, Lernmark Å, Ludvigsson J, Marcus C, Samuelsson U, Örtqvist E, Larsson HE. Thyroid and Islet Autoantibodies Predict Autoimmune Thyroid Disease at Type 1 Diabetes Diagnosis. J Clin Endocrinol Metab 2017; 102:1277-1285. [PMID: 28388722 PMCID: PMC5460724 DOI: 10.1210/jc.2016-2335] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/07/2016] [Indexed: 12/30/2022]
Abstract
CONTEXT Screening of autoimmune thyroid disease in children with type 1 diabetes is important but varies between clinics. OBJECTIVE To determine the predictive value of thyroid autoantibodies, thyroid function, islet autoantibodies, and HLA-DQ at diagnosis of type 1 diabetes for autoimmune thyroid disease during follow-up. SETTING Forty-three Swedish pediatric endocrinology units. DESIGN, PATIENTS, AND MAIN OUTCOME MEASURES At diagnosis of type 1 diabetes, autoantibodies against thyroid peroxidase (TPOAb), thyroglobulin (TGAb), glutamic acid decarboxylase (GADA), insulin, insulinoma-associated protein-2, and 3 variants of zinc transporter 8 (ZnT8W/R/QA) HLA-DQA1-B1 genotypes and thyroid function were analyzed in 2433 children. After 5.1 to 9.5 years, information on thyroxine treatment was gathered from the Swedish National Board of Health and Welfare's Prescribed Drug Register. RESULTS Thyroxine was prescribed to 6% of patients. In patients <5 years of age, female sex [hazard ratio (HR) = 4.60; P = 0.008] and GADA (HR = 5.80; P = 0.02) were predictors. In patients 5 to 10 years old, TPOAb (HR = 20.56; P < 0.0001), TGAb (HR = 3.40; P = 0.006), and thyroid-stimulating hormone (TSH) (HR = 3.64; P < 0.001) were predictors, whereas in 10 to 15 year olds, TPOAb (HR = 17.00; P < 0.001) and TSH (HR = 4.11; P < 0.001) predicted thyroxine prescription. CONCLUSION In addition to TPOAb and TSH, GADA at diagnosis of type 1 diabetes is important for the prediction of autoimmune thyroid disease in children <5 years of age.
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Affiliation(s)
- Berglind Jonsdottir
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Christer Larsson
- Department of Laboratory Medicine, Lund University, SE-211 85 Lund, Sweden
| | - Annelie Carlsson
- Department of Pediatrics, Lund University, Skåne University Hospital, SE-211 85 Lund, Sweden
| | - Gun Forsander
- Department of Pediatrics, The Queen Silvia Children's Hospital, SE-416 86 Gothenburg, Sweden
| | - Sten Anders Ivarsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University Hospital, SE-58183 Linköping, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University Hospital, SE-58183 Linköping, Sweden
| | - Eva Örtqvist
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Helena Elding Larsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
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Al-Hakami AM. Pattern of thyroid, celiac, and anti-cyclic citrullinated peptide autoantibodies coexistence with type 1 diabetes mellitus in patients from Southwestern Saudi Arabia. Saudi Med J 2017; 37:386-91. [PMID: 27052281 PMCID: PMC4852016 DOI: 10.15537/smj.2016.4.13571] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives: To investigate the seroprevalence of coexisting autoantibodies among type 1 diabetes mellitus (T1DM) patients, and to look for possible correlations with age at diagnosis, diabetes duration, and glycemic control. Methods: This is a cross-sectional study conducted at Aseer Central Hospital, Abha, Kingdom of Saudi Arabia from March 2013 to June 2014. A total of 202 T1DM patients were screened for serum anti-thyroglobulin (TG), anti-thyroid peroxidase (TPO), anti-tissue transglutaminase (aTTG), anti-endomysial (EMA), and anti-cyclic citrullinated peptide (anti-CCP) antibodies along with glycated hemoglobin, and biometric data. Results: From the 202 T1DM patients (96 males, and 106 females) (mean age: 11.3 years), 33 (16.3%) were positive for thyroid autoantibodies. Specifically, 19 (9.4%) were positive for TG and 25 (12.8%) were positive for TPO, and 11 were double positive. There were 21 (10.4%) patients that showed a double positive for both aTTG-IgA and EMA, and only one case of T1DM was positive for anti-CCP. No significant correlations were noticed between the presence of autoantibodies and the age at diagnosis, diabetes duration, body mass index, and glycemic control. Conclusion: The prevalence of thyroid and celiac disease autoantibodies is high among T1DM patients, while anti-CCP remains low and might be weakly associated with T1DM in the southwestern region of Saudi Arabia. No significant correlation between the age at T1DM diagnosis, duration, and glycemic control, and the presence of autoantibodies was found.
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Affiliation(s)
- Ahmed M Al-Hakami
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia. E-mail.
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Singh S, Usha, Singh G, Agrawal NK, Singh RG, Kumar SB. Prevalence of Autoantibodies and HLA DR, DQ in Type 1 Diabetes Mellitus. J Clin Diagn Res 2016; 10:EC09-13. [PMID: 27630850 DOI: 10.7860/jcdr/2016/18657.8163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Type I diabetes Mellitus (T1DM) is caused by autoimmune destruction of β-cells of pancreas. Two forms of T1DM are known called as 1A (autoimmune) and 1B (idiopathic). AIM Aim was to study the prevalence of Anti-TTG IgA, Anti-TPO, GADA, ZnT8 and IA-2 autoantibodies and HLA DR and DQ genes and its diagnostic value in T1DM. MATERIALS AND METHODS Thirty four T1DM patients, 59 type 2 diabetes mellitus (T2DM) patients and 28 healthy controls were included in study. Antibodies levels were estimated by ELISA and HLA typing was performed by SSP-PCR method. RESULT The prevalence of various autoantibodies in T1DM were Anti-TTG 14.7%, Anti-TPO 17.65%, GADA 38.23%, ZnT8 11.76% and IA-2 5.88%. Only GADA and ZnT8 were significantly positive in T1DM. GADA (66.67%) and ZnT8 (33.33%) positivity was more in patients below 15 years age while levels of other antibodies were higher after 15 years age. All autoantibodies were detected in higher frequency in T1DM than in T2DM and controls. HLA DR and DQ typing showed highly significant increase in DRB1*0301 (61.76%, p=0.00) and DQB1*0201 (64.71%, p=0.00) in T1DM. Subjects with HLA DRB1*0301 and DQB1*0201 had 80-100% positive prevalence of GADA, ZnT8, IA-2, Anti-TTG and Anti-TPO autoantibodies. CONCLUSION Combination of GADA antibody with DRB1 and DQB1 estimation improved diagnosis of T1A than insulin antigen specific antibodies alone.
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Affiliation(s)
- Shailja Singh
- Research Scholar, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, UP, India
| | - Usha
- Professor and Incharge, UGC Advanced Immunodiagnostic Training and Research Centre, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, UP, India
| | - Gyanendra Singh
- Junior Resident, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, UP, India
| | - Neeraj Kumar Agrawal
- Professor, Department of Endocrinology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, UP, India
| | - Rana Gopal Singh
- Professor, Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, UP, India
| | - Shashi Bhushan Kumar
- Service Senior Resident, Department of Pathology, Institute of Medical Sciences, Banaras Hindu University , Varanasi, UP, India
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Głowińska-Olszewska B, Michalak J, Łuczyński W, Del Pilar Larosa M, Chen S, Furmaniak J, Smith BR, Bossowski A. Organ-specific autoimmunity in relation to clinical characteristics in children with long-lasting type 1 diabetes. J Pediatr Endocrinol Metab 2016; 29:647-56. [PMID: 27008690 DOI: 10.1515/jpem-2015-0190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 02/09/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the prevalence of diabetes and other organ-specific autoantibodies (Ab) associated with various autoimmune conditions, in Polish children with type 1 diabetes mellitus (T1DM). METHODS In this study 114 patients, aged 13.4 years, with mean diabetes duration 5.2 years were included. Ab to islet cell antigens: glutamic acid decarboxylase (GAD), insulinoma antigen 2 (IA-2), zinc transporter 8 (ZnT8), together with thyroid peroxidase Ab (TPO Ab), thyroglobulin Ab (Tg Ab), tissue transglutaminase Ab (tTG Ab) and 21-hydroxylase Ab (21-OH Ab) were measured. RESULTS The prevalence of at least one diabetes associated Ab was found in 87%, with the highest prevalence of 64% for ZnT8 Ab. In patients with disease duration <5 years, at least one antibody was present in 90%, the most prevalent was ZnT8 Ab (72%). In patients with duration >10 years, 50% had at least one antibody. The prevalence of other than islet cell autoimmunity was high (34%). Thyroid Ab were detected in 26% patients, 42% in girls vs. 8% in boys, p<0.001. tTG Ab were found in 11% patients, with a greater prevalence in children with early onset (p=0.01). 21-OH Ab were found in 2.6% T1DM patients. CONCLUSIONS Islet Ab were found in most T1DM children and remained positive even 10 years after onset. ZnT8 Ab emerged as an important marker for the diagnosis of T1DM in the Polish children. Screening for non-diabetes Ab in T1DM may be helpful in identifying subclinical cases of autoimmune thyroid, celiac or Addison's disease (AD).
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Rogowicz-Frontczak A, Pilacinski S, Chwialkowska AT, Wierusz-Wysocka B, Zozulińska-Ziółkiewicz D. Patients with diabetes type 1 and thyroid autoimmunity have low prevalence of microangiopathic complications. Endocrine 2016; 51:185-8. [PMID: 26044140 DOI: 10.1007/s12020-015-0643-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Anita Rogowicz-Frontczak
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza 2, 60-834, Poznan, Poland.
| | - Stanilaw Pilacinski
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza 2, 60-834, Poznan, Poland
| | - Anna Teresa Chwialkowska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza 2, 60-834, Poznan, Poland
| | - Bogna Wierusz-Wysocka
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza 2, 60-834, Poznan, Poland
| | - Dorota Zozulińska-Ziółkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Mickiewicza 2, 60-834, Poznan, Poland
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Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmun Rev 2015; 14:781-97. [DOI: 10.1016/j.autrev.2015.05.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/06/2015] [Indexed: 12/16/2022]
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Pham-Short A, Donaghue KC, Ambler G, Phelan H, Twigg S, Craig ME. Screening for Celiac Disease in Type 1 Diabetes: A Systematic Review. Pediatrics 2015; 136:e170-6. [PMID: 26077482 DOI: 10.1542/peds.2014-2883] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Prevalence rates of type 1 diabetes (T1D) and celiac disease (CD) vary from 1.6% to 16.4% worldwide. Screening guidelines are variable and not evidence based. Our aim was to conduct a systematic review of CD in T1D. METHODS Medline, Embase, and the Cochrane Library were searched. Studies were limited to those in English and in humans. We selected longitudinal cohort studies screening for CD in T1D with at least 5 years of follow-up. Screening rates, characteristics, and prevalence of biopsy-proven CD in people with T1D were extracted. RESULTS We identified 457 nonduplicate citations; 48 were selected for full-text review. Nine longitudinal cohort studies in 11,157 children and adolescents with 587 cases of biopsy-proven CD met the inclusion criteria. Median follow-up was 10 years (range: 5-18 years). The weighted pooled prevalence of CD was 5.1% (95% confidence interval: 3.1-7.4%). After excluding 41 cases with CD onset before T1D, CD was diagnosed in 218 of 546 (40%) subjects within 1 year, in 55% within 2 years, and in 79% within 5 years of diabetes duration. Two studies (478 cases) reported higher rates of CD in children aged <5 years at T1D diagnosis. The duration of follow-up varied across the included studies. CD screening frequency progressively decreased with increased T1D duration. CONCLUSIONS Because most cases of CD are diagnosed within 5 years of T1D diagnosis, screening should be considered at T1D diagnosis and within 2 and 5 years thereafter. CD screening should be considered at other times in patients with symptoms suggestive of CD. More research is required to determine the screening frequency beyond 5 years of diabetes duration.
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Affiliation(s)
- Anna Pham-Short
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Geoffrey Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia
| | | | - Stephen Twigg
- Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital and Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, Australia; and
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia; School of Women's and Child's Health, University of New South Wales, Sydney, Australia
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Balsamo C, Zucchini S, Maltoni G, Rollo A, Martini AL, Mazzanti L, Pession A, Cassio A. Relationships between thyroid function and autoimmunity with metabolic derangement at the onset of type 1 diabetes: a cross-sectional and longitudinal study. J Endocrinol Invest 2015; 38:701-7. [PMID: 25722223 DOI: 10.1007/s40618-015-0248-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/25/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Type 1 diabetes (T1DM) is an autoimmune disease often associated with thyroid abnormalities. PURPOSE We investigated the correlation between thyroid function and metabolic derangement at onset and the influence of autoimmunity on thyroid function at onset and subsequently. METHODS We evaluated 152 patients diagnosed with T1DM between 2000 and 2012 at onset and during a mean follow-up of 5.45 ± 2.8 years. Thyroid function at onset was correlated with metabolic derangement (degree of acidosis, metabolic control and adrenal function) and compared with that of 78 healthy children. Follow-up consisted of regular evaluation of thyroid function and autoimmunity. RESULTS Thyroid hormonal pattern was not influenced at onset by thyroid autoimmunity, but only by metabolic derangement: pH and base excess in fact were significantly lower in patients with impaired thyroid function (p < 0.0001). Patients presenting normal thyroid function at onset showed a reduced conversion from FT4 to FT3 compared to nondiabetic children (FT3/FT4 0.3 ± 0.4 in the control group, 0.24 ± 0.4 in diabetic patients, p < 0.0001). Multiple regression analysis showed the highest correlation (negative) between FT3 levels at onset and base excess (p < 0.005). Thyroid abnormalities related to metabolic derangement disappeared during follow-up. Patients with thyroid antibodies at T1DM onset were at higher risk to require levothyroxine treatment during follow-up (p < 0.05). CONCLUSIONS Thyroid function at T1DM onset is mainly influenced by metabolic derangement, irrespective of thyroid autoimmunity. Antithyroid antibodies evaluation at T1DM onset may be helpful to define which patients are at higher risk of developing hypothyroidism.
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Affiliation(s)
- C Balsamo
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - S Zucchini
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy.
| | - G Maltoni
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A Rollo
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A L Martini
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - L Mazzanti
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A Pession
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
| | - A Cassio
- Pediatric Department, Ospedale Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40100, Bologna, Italy
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Descripción de las enfermedades autoinmunes acompañantes de la diabetes mellitus tipo 1 en un área sanitaria. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.avdiab.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kawasaki E. Type 1 diabetes and autoimmunity. Clin Pediatr Endocrinol 2014; 23:99-105. [PMID: 25374439 PMCID: PMC4219937 DOI: 10.1297/cpe.23.99] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/22/2014] [Indexed: 01/25/2023] Open
Abstract
Type 1 diabetes (T1D) is an organ-specific autoimmune disease caused by the autoimmune
response against pancreatic β cells. T1D is often complicated with other autoimmune
diseases, and anti-islet autoantibodies precede the clinical onset of disease. The most
common coexisting organ-specific autoimmune disease in patients with T1D is autoimmune
thyroid disease, and its frequency is estimated at > 90% among patients with T1D and
autoimmune diseases. The prevalence of anti-thyroid antibodies in children with T1D at
disease onset is about 20% and is particularly common in girls. Furthermore, patients with
anti-thyroid antibodies are 18 times more likely to develop thyroid disease than patients
without anti-thyroid antibodies. Therefore, for early detection of autoimmune thyroid
disease in children with T1D, measurement of anti-thyroid antibodies and TSH at T1D onset
and in yearly intervals after the age of 12 yr is recommended. Anti-islet autoantibodies
are predictive and diagnostic markers for T1D. The most frequently detected autoantibodies
in Japanese patients are GAD autoantibodies (~80%) followed by IA-2 autoantibodies (~60%),
insulin autoantibodies (~55%) and ZnT8 autoantibodies (~50%). In a combined analysis, 94%
of Japanese patients with T1D can be defined as having type 1A diabetes. Furthermore,
autoantibodies to ZnT8 and IA-2 are associated with childhood-onset and acute-onset
patients. Thus, it is important to develop a diagnostic strategy for patients with type 1A
diabetes in consideration of the age or mode of disease onset.
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Affiliation(s)
- Eiji Kawasaki
- Department of Diabetes and Metabolism, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
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Kordonouri O, Klingensmith G, Knip M, Holl RW, Aanstoot HJ, Menon PSN, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2014. Other complications and diabetes-associated conditions in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:270-8. [PMID: 25182319 DOI: 10.1111/pedi.12183] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 12/27/2022] Open
Affiliation(s)
- Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Children's Hospital auf der Bult, Hannover, Germany
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Arslan D, Merdin A, Tural D, Temizel M, Akın O, Gündüz S, Tatlı AM, Avcı F, Uysal M. The effect of autoimmunity on the development time of microvascular complications in patients with type 1 diabetes mellitus. Med Sci Monit 2014; 20:1176-9. [PMID: 25007947 PMCID: PMC4103811 DOI: 10.12659/msm.890742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Type 1 diabetes mellitus (DM) is an autoimmune disease with chronic complications that is becoming more frequent as life expectancy of diabetics has increased owing to improved methods of detection and better management. In this study, we investigated whether the presence of autoimmunity can be used in predicting the development time of microvascular complications. Material/Methods Our study included 52 patients with type 1 diabetes mellitus (DM). The subjects had developed microvascular complications and they had been tested for anti-GAD (glutamic acid decarboxylase) antibodies and/or islet-cell antibodies (ICA). In the assessment of microvascular complications, we used ocular fundus examination, electromyography (EMG), and 24-h urine microalbuminuria tests. Results Of the patients included in the study, 30 were female and 22 were male. Of all patients characterized for the existence of diabetic complications, 36 of 52 had both diabetic retinopathy and diabetic nephropathy, 5 patients had diabetic neuropathy, and 11 patients had diabetic retinopathy only. At the diagnosis of diabetes, 20 in 52 patients tested negative for autoantibodies (anti-GAD and anti-ICA), while 32 of 52 tested positive for anti-GAD and/or anti-ICA. The mean HbA1C level of autoantibody-negative patients was 7.7%, while antibody-positive patients had slightly higher HbA1c levels (7.9%). However, this difference was not statistically significant (p>0.05). The mean development time of microvascular complications in autoantibody-positive patients was calculated as 11: 40±6.46 years, and in patients with negative autoimmunity results it was 10.91±6.70 years. Conclusions The presence of diabetes-related autoantibodies (DRAs) in patients with type 1 diabetes mellitus does not have a significant effect on the development time of diabetic microvascular complications.
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Affiliation(s)
- Deniz Arslan
- Department of Internal Medicine, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Alparslan Merdin
- Department of Internal Medicine, Akdeniz University Hospital, Antalya, Turkey
| | - Deniz Tural
- Department of Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Mustafa Temizel
- Department of Internal Medicine, Ministry of Health Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Olgun Akın
- Department of Nephrology, Akdeniz University Hospital, Antalya, Turkey
| | - Seyda Gündüz
- Department of Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Ali Murat Tatlı
- Department of Oncology, Akdeniz University Hospital, Antalya, Turkey
| | - Fatma Avcı
- Department of Internal Medicine, Akdeniz University Hospital, Antalya, Turkey
| | - Mükremin Uysal
- Department of Oncology, Akdeniz University Hospital, Antalya, Turkey
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Screening for thyroid disease among children and adolescents with type 1 diabetes mellitus. ALEXANDRIA JOURNAL OF MEDICINE 2014. [DOI: 10.1016/j.ajme.2013.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Shun CB, Donaghue KC, Phelan H, Twigg SM, Craig ME. Thyroid autoimmunity in Type 1 diabetes: systematic review and meta-analysis. Diabet Med 2014; 31:126-35. [PMID: 24103027 DOI: 10.1111/dme.12318] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2013] [Indexed: 11/28/2022]
Abstract
AIMS To review the incidence and evidence for screening for thyroid autoimmunity and thyroid dysfunction in Type 1 diabetes. METHODS Systematic review and meta-analysis. Inclusion criteria were prospective cohort studies screening for thyroid autoimmunity and/or dysfunction (defined as an abnormal thyroid-stimulating hormone level) in Type 1 diabetes. Exclusion criteria included pregnancy and thyroid dysfunction before diabetes onset. Outcomes examined were: incidence of thyroid autoimmunity and/or dysfunction; association between thyroid autoimmunity and dysfunction; and cost-effectiveness. Data sources were MEDLINE, EMBASE, the Cochrane Library, manual searching and contact with authors, with limitations to English language and human studies. Meta-analysis was performed using random effects models. RESULTS We identified 14 eligible studies, involving 2972 young people and 789 adults with Type 1 diabetes. Follow-up ranged from 1-18 years. None of the studies were of good methodological quality (Newcastle Ottowa Scale score > 7). The incidence of thyroid dysfunction (11 studies) ranged from 27 (95% CI 15-45) to 246 (95% CI 118-453) per 10 000 patient-years and thyroid autoimmunity (four studies) from 13 (95% CI 0.3-71) to 326 (95% CI 194-510). The risk of thyroid dysfunction was higher in those with thyroid autoimmunity: summary risk ratio 25 (95% CI 9-71) and was higher in children (49, 95% CI 16-150) compared with adults (7, 95% CI 3-13). No studies examined cost-effectiveness of screening. CONCLUSIONS There is a markedly increased risk of thyroid dysfunction in people with Type 1 diabetes and thyroid autoimmunity. The optimal method or frequency of screening could not be determined from available data. Future studies should examine whether screening improves clinical outcomes in this population.
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Affiliation(s)
- C B Shun
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Pham-Short A, C Donaghue K, Ambler G, K Chan A, Hing S, Cusumano J, E Craig M. Early elevation of albumin excretion rate is associated with poor gluten-free diet adherence in young people with coeliac disease and diabetes. Diabet Med 2014; 31:208-12. [PMID: 24117620 DOI: 10.1111/dme.12329] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/06/2013] [Accepted: 09/19/2013] [Indexed: 12/18/2022]
Abstract
AIMS There are conflicting data on microvascular complications in coexisting Type 1 diabetes and coeliac disease. We compared complications rates in youth with or without coeliac disease and examined the association between gluten-free diet adherence and complications. METHODS This was a comparative study of adolescents (2510 without coeliac disease, 129 with coeliac disease); 60 (47%) did not adhere to a gluten-free diet--defined as elevated anti-tissue transglutaminase or endomysial immunoglobulin A titres. Retinopathy was detected using 7-field fundal photography and albumin excretion rate by timed overnight urine collections, with early elevation defined as albumin excretion rate ≥ 7.5 μg/min. Logistic regression was used to examine the association between complications and explanatory variables, including coeliac disease vs. no coeliac disease, gluten-free diet adherence vs. non-adherence, diabetes duration and HbA1c . RESULTS Median age at last assessment was 16.5 years. Those with coeliac disease vs. those without were younger at diabetes diagnosis (7.1 vs. 8.6 years, P < 0.001) and had longer diabetes duration (9.3 vs. 7.2 years, P < 0.001). HbA1c was lower in those with coeliac disease vs. those without (67 vs. 70 mmol/mol, 8.3 vs. 8.6%, P = 0.04) and adherence to a gluten-free diet vs. non-adherence (66 vs. 72 mmol/mol, 8.2 vs. 8.7%, P = 0.003). There were no differences in complication rates between those with coeliac disease vs. those without (retinopathy 22 vs. 23%, elevated albumin excretion rate 31 vs. 28%). Non-adherence to a gluten-free diet was associated with elevated albumin excretion rate (40 vs. 23%, P = 0.04). In multivariable logistic regression, elevated albumin excretion rate was associated with non-adherence to a gluten-free diet (odds ratio 2.37, 95% CI 1.04-5.40, P = 0.04) and diabetes duration (odds ratio 1.13, 95% CI 1.02-1.25, P = 0.03), but not HbA1c . CONCLUSIONS While glycaemic control is better in patients with coeliac disease, non-adherence to a gluten-free diet is associated with elevated albumin excretion rate. The possible protection of a gluten-free diet on complications warrants further investigation.
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Affiliation(s)
- A Pham-Short
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead; Discipline of Paediatrics and Child Health, University of Sydney, Sydney
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38
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Le diabète de type 1 chez les enfants et les adolescents. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.03.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wherrett D, Huot C, Mitchell B, Pacaud D. Le diabète de type 1 chez les enfants et les adolescents. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Parkkola A, Härkönen T, Ryhänen SJ, Ilonen J, Knip M. Extended family history of autoimmune diseases and phenotype and genotype of children with newly diagnosed type 1 diabetes. Eur J Endocrinol 2013; 169:171-8. [PMID: 23698601 DOI: 10.1530/eje-13-0089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Based on the concept of clustering autoimmunity, children with a positive family history of autoimmunity could be expected to have a different pathogenetic form of type 1 diabetes (T1D) and thus a stronger autoimmune reactivity against β-cells and an increased prevalence of the HLA-DR3-DQ2 haplotype. DESIGN AND METHODS We tested this hypothesis in a cross-sectional observational study from the Finnish Pediatric Diabetes Register. HLA class II genotypes and β-cell autoantibodies were analyzed, and data on the extended family history of autoimmunity and clinical markers at diagnosis were collected with a structured questionnaire from 1488 children diagnosed with T1D under the age of 15 years (57% males). RESULTS Only 23 children (1.5%) had another autoimmune disease (AID) known at diagnosis, and they had a milder metabolic decompensation at diabetes presentation. One-third (31.4%) had at least one relative with an AID other than T1D with affected mothers being overrepresented (8.2%) compared with fathers (2.8%). The children with a positive family history of other AIDs had higher levels of islet cell antibodies (P=0.003), and the HLA-DR3-DQ2 haplotype in the children was associated with celiac disease in the extended family (P<0.001), but not with an increased frequency of autoimmune disorders, in general. CONCLUSIONS Approximately one-third of children with newly diagnosed T1D have a first- and/or second-degree relative affected by an AID. Our data do not consistently support the hypothesis of differential pathogenetic mechanisms in such children.
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Affiliation(s)
- Anna Parkkola
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PO Box 22, FI-00014 Helsinki, Finland
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Jonsdottir B, Andersson C, Carlsson A, Delli A, Forsander G, Ludvigsson J, Marcus C, Samuelsson U, Ortqvist E, Lernmark A, Ivarsson SA, Larsson HE. Thyroid autoimmunity in relation to islet autoantibodies and HLA-DQ genotype in newly diagnosed type 1 diabetes in children and adolescents. Diabetologia 2013; 56:1735-42. [PMID: 23666211 DOI: 10.1007/s00125-013-2934-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/22/2013] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to investigate, in children newly diagnosed with type 1 diabetes: (1) the prevalence of autoantibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TGAb); and (2) the association between TPOAb, TGAb or both, with either islet autoantibodies or HLA-DQ genes. METHODS Blood samples from 2,433 children newly diagnosed with type 1 diabetes were analysed for TPOAb and TGAb in addition to autoantibodies against arginine zinc transporter 8 (ZnT8RA), tryptophan zinc transporter 8 (ZnT8WA), glutamine zinc transporter 8 (ZnT8QA), glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma-associated protein-2 (IA-2A), HLA-DQA-B1 genotypes, thyroid-stimulating hormone (TSH) and free thyroxine (T4). RESULTS At type 1 diabetes diagnosis, 12% of the children had thyroid autoantibodies (60% were girls; p < 0.0001). GADA was positively associated with TPOAb (p < 0.001) and with TGAb (p < 0.001). In addition, ZnT8A was associated with both TPOAb (p = 0.039) and TGAb (p = 0.015). DQB1*05:01 in any genotype was negatively associated with TPOAb (OR 0.55, 95% CI 0.37, 0.83, p value corrected for multiple comparisons (p c) = 0.012) and possibly with TGAb (OR 0.55, 95% CI 0.35, 0.87, p c = 0.07). Thyroid autoimmunity in children newly diagnosed with type 1 diabetes was rarely (0.45%) associated with onset of clinical thyroid disease based on TSH and free T4. CONCLUSIONS/INTERPRETATION GADA and ZnT8A increased the risk for thyroid autoimmunity at the time of clinical diagnosis of type 1 diabetes, while HLA-DQB1*05:01 reduced the risk. However, the associations between thyroid autoimmunity and HLA-DQ genotype were weak and did not fully explain the co-occurrence of islet and thyroid autoimmunity.
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Affiliation(s)
- B Jonsdottir
- Department of Clinical Sciences, Skåne University Hospital SUS, Malmö, Sweden.
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Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Almeida MHD, Dantas JR, Barone B, Serfaty FM, Kupfer R, Albernaz M, Bencke MR, Zajdenverg L, Rodacki M, Oliveira JEPD. Residual C-peptide in patients with Type 1 diabetes and multiethnic backgrounds. Clinics (Sao Paulo) 2013; 68:123-6. [PMID: 23420171 PMCID: PMC3552451 DOI: 10.6061/clinics/2013(01)rc02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate serum C-peptide in 88 patients from a multiethnic population with Type-1 diabetes and variable disease durations. METHOD Eighty-eight patients with a mean disease duration of 8.1 +7.6 years were included and underwent C-peptide measurement before and after glucagon stimulation. Chi-squared and Mann Whitney U-tests were used to compare the variables between groups (all two-tailed, α = 0.05). Spearmans correlation coefficient was used to test the association between the continuous variables. Logistic regression was used for the multivariate analysis. Twenty-eight (31.8%) individuals had significantly detectable C-peptide levels after stimuli, particularly those with a shorter disease duration (p<0.001). RESULTS Patients with detectable C-peptide levels required lower insulin doses (p<0.009) and had similar HbA1C results (p = 0.182) and fewer chronic complications (p = 0.029). CONCLUSION C-peptide detection was common in Type-1 diabetics, particularly shortly after being diagnosed. This result may have clinical implications.
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Affiliation(s)
- Mirella Hansen de Almeida
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Nutrology Department, Rio de Janeiro/RJ, Brazil
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Pham-Short A, Donaghue KC, Ambler G, Chan AK, Craig ME. Coeliac disease in Type 1 diabetes from 1990 to 2009: higher incidence in young children after longer diabetes duration. Diabet Med 2012; 29:e286-9. [PMID: 22672045 DOI: 10.1111/j.1464-5491.2012.03720.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To determine the incidence of coeliac disease in young people with Type 1 diabetes and to examine the effect of age at diabetes onset and disease duration. METHODS This was a clinic-based observational cohort study of 4379 people aged ≤ 18 years (49% male) between 1990 and 2009 from Sydney, Australia. Screening for coeliac disease was performed at diagnosis and 1-2 yearly using anti-endomysial and/or anti-tissue transglutaminase immunoglobulin A (IgA) antibodies. Coeliac disease was diagnosed by small bowel biopsy based on Marsh score ≥ III. RESULTS Coeliac disease was confirmed by biopsy in 185; of these, 61 (33%) were endomysial or tissue transglutaminase IgA antibody-positive at diabetes diagnosis. Mean age at diabetes onset was 6.6 ± 4.0 vs. 8.4 ± 4.1 years in those without coeliac disease (P < 0.001). Mean incidence was 7.7 per 1000 person years (95% CI 6.6-8.9) over 20 years. Incidence was higher in children aged < 5 years at diabetes diagnosis (10.4 per 1000 person years) vs. ≥ 5 years (6.4 per 1000), incidence rate ratio 1.6 (95% CI 1.2-2.2, P = 0.002). Coeliac disease was diagnosed after 2, 5 and 10 years of diabetes in 45, 78 and 94% of cases, respectively. Median time to coeliac disease diagnosis was longer in children aged < 5 years at diabetes onset (3.3 years) compared with older children (0.7 years, P < 0.001). CONCLUSIONS Coeliac disease is common in young people with Type 1 diabetes; the risk is greatest with diabetes onset < 5 years, but after longer diabetes duration. Screening for coeliac disease should be performed at diabetes diagnosis and for at least 10 years in young children.
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Affiliation(s)
- A Pham-Short
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, NSW, Australia
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Greco D, Pisciotta M, Gambina F, Maggio F. Graves' disease in subjects with type 1 diabetes mellitus: a prevalence study in western Sicily (Italy). Prim Care Diabetes 2011; 5:241-244. [PMID: 21704580 DOI: 10.1016/j.pcd.2011.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 05/03/2011] [Accepted: 06/02/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prevalence of Graves' disease in patients with type 1 diabetes mellitus all coming from a defined geographical area (western Sicily-Italy) and to investigate the clinical features of these subjects. METHODS The records of 470 consecutive patients with type 1 diabetes mellitus referred in a 5-year period were analyzed. RESULTS During the period of the survey, out of 470 patients with type 1 diabetes, 14 (3%) had a previous diagnosis of Graves' disease. There were 9 female and 5 male; these patients showed a high age at diabetes onset (mean 38 years). Diagnosis of Graves' disease was often pre-existing or simultaneous to that of diabetes. Vitiligo was coexisting in 4 subjects; none of them presented other autoimmune diseases. Graves' orbitopathy was present in two cases. CONCLUSIONS Our data confirm the frequent association between Graves' disease and type 1 diabetes. Graves' disease often preceded diagnosis of type 1 diabetes, particularly in female subjects with a high age at diabetes onset; therefore, in these subjects, an active search for the presence of pancreatic autoimmunity is warranted for many years after thyroid dysfunction appearance.
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Affiliation(s)
- Domenico Greco
- Division of Diabetology, Paolo Borsellino Hospital, Marsala, Italy.
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Ghawil M, Tonutti E, Abusrewil S, Visentini D, Hadeed I, Miotti V, Pecile P, Morgham A, Tenore A. Autoimmune thyroid disease in Libyan children and young adults with type 1 diabetes mellitus. Eur J Pediatr 2011; 170:983-7. [PMID: 21210146 DOI: 10.1007/s00431-010-1386-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/13/2010] [Indexed: 11/29/2022]
Abstract
UNLABELLED Diabetes mellitus is a common autoimmune endocrine disorder associated with organ-specific autoantibodies which are frequently detected at the time of diagnosis. Some of these antibodies are specific to the pancreas (GAD, IA2, ICA) while others are related to different autoimmune diseases. AIM OF THE STUDY To define the prevalence of thyroid autoimmune disease in Libyan patients with type 1 diabetes mellitus (T1DM) since no similar studies have been performed in Libya. MATERIALS AND METHODS Blood samples were collected from 218 patients with T1DM who are followed by the Pediatric Department, Tripoli Medical Center, Libya. All sera were analyzed in Italy (Laboratory of Immunopathology and Allergy, Udine). The patients were composed of 123 females (56.4%) and 95 males (43.6%), mean age 12.2 ± 4.6 years (range 2.1-24.5 years), mean duration of diabetes 4.7 ± 4.0 years (range 0.1-17.5 years). Sera were tested for anti-thyroperoxidase (TPO) and anti-thyroglobulin antibodies (TG). TSH and FT4 concentrations were measured in all subjects. GAD, IA-2 was also measured. RESULTS Of the diabetic children, 23.4% were positive for anti-microsomal peroxidase antibodies (TPO-Ab) and 7.8% for antithyroglobulin antibodies (TG-Ab); whereas 6.9% of the patients were positive for both TPO-Ab and TG-Ab. Of the T1DM patients who were positive for TPO-Ab, 66.6% were females. The majority (57%) of the patients who were positive for TPO had diabetes for longer than 5 years. Five patients (2.3%) had evidence of subclinical hypothyroidism whereas two patients (0.9%) had overt hypothyroidism. Two patients had subclinical hyperthyroidism and two (0.9%) had overt hyperthyroidism. Interestingly, 16.2% of patients were positive for both thyroid and pancreatic antibodies. CONCLUSIONS The prevalence of autoimmune thyroid disease in type 1 diabetic patients is higher than in the general population. A routine screening strategy should be implemented with the determination of anti-thyroid antibodies and TSH in type 1 diabetic patients, particularly in girls, and in patients with diabetes of more than 5 years duration. Patients who have positive TPO antibodies may need the assessment of thyroid function at shorter intervals.
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Affiliation(s)
- Millad Ghawil
- Department of Pediatrics, Azienda Ospedaliero-Universitaria di Udine, DPMSC, University of Udine, Udine, Italy.
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Jin P, Huang G, Lin J, Yang L, Xiang B, Zhou W, Zhou Z. High titre of antiglutamic acid decarboxylase autoantibody is a strong predictor of the development of thyroid autoimmunity in patients with type 1 diabetes and latent autoimmune diabetes in adults. Clin Endocrinol (Oxf) 2011; 74:587-92. [PMID: 21470281 DOI: 10.1111/j.1365-2265.2011.03976.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) is frequently associated with autoimmune thyroid diseases (AITD), but little is known about the risk of AITD in latent autoimmune diabetes in adults (LADA). We evaluated the genetic and immunological factors involved in the development of thyroid autoimmunity in patients with LADA and T1DM. PATIENTS AND MEASUREMENTS One hundred and ninety T1DM and 135 LADA patients were recruited in the study. Thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb), glutamic acid decarboxylase antibody (GADA) and thyroid function were measured. The cytotoxic-lymphocyte-associated antigen-4 (CTLA-4) +49A/G and CT60 polymorphisms and the human leucocyte antigen (HLA)-DQA1-DQB1 genotype were determined. RESULTS The prevalence of thyroid antibodies (TGAb and/or TPOAb) and thyroid dysfunction was 27·4% and 9·5% in patients with T1DM, and 21·5% and 11·1% in patients with LADA. Thyroid-antibody-positive T1DM patients had higher frequencies of GADA and HLA-DQA1*03-DQB1*0401 haplotypes than thyroid-antibody negatives (P < 0·05). Thyroid-antibody-positive LADA patients had higher GADA titre, lower C-peptide levels and higher frequencies of HLA-DQA1*03-DQB1*0401 haplotypes (P < 0·05). The CTLA-4 +49A/G and CT60 polymorphism was associated with T1DM complicated with thyroid autoimmunity (OR = 2·33 and 2·54). Logistic regression revealed that only high-titre GADA was associated with development of thyroid autoimmunity in patients with T1DM and LADA (OR = 3·50 and 3·10, respectively), and the presence of thyroid antibody predicted high risk for thyroid dysfunction in patients with T1DM and LADA (OR = 9·25 and 10·70, respectively). CONCLUSION Regular screening of thyroid antibody and function are recommended, especially in patients with T1DM and LADA with high GADA titre.
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Affiliation(s)
- Ping Jin
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Diabetes Center, Metabolic Syndrome Research Center, Institute of Metabolism and Endorcrinology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
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Serfaty FM, Dantas JR, Almeida MH, Duarte JDG, Kupfer R, Campos F, Zajdenverg L, Milech A, Rodacki M, Oliveira JEPD. [GADA persistence and detectable C peptide in patients with long standing diabetes mellitus type 1]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2010; 54:449-54. [PMID: 20694405 DOI: 10.1590/s0004-27302010000500004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 04/05/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if GADA+ and detectable CP had any influence in other autoimmune diseases, glycemic control, and risks of retinopathy in diabetes mellitus type 1 (T1DM) lasting longer than 3 years of duration. SUBJECTS AND METHODS Fifty T1DM subjects were interviewed, performed fundoscopic examination, and measured CP before and after glucagon, HbA1C, and GADA. RESULTS GADA+ (n = 17) had a higher frequency of other autoimmune diseases when compared to GADA (p = 0.02). Detectable CP was also associated with a higher prevalence of these diseases (p = 0.03), although, retinopathy was not influenced by either one. Detectable CP had no influence in the glycemic control (mean HbA1C) (p = 0.28). However, insulin daily doses were lower in this group (0.62 vs. 0.91 U/kg/day; p = 0.004). CONCLUSION Although not recommend as a marker of other autoimmune diseases, GADA+ seems to be not only a pancreatic autoimmunity signal. Detectable CP may also have some promising influence in detecting these diseases. Neither influenced the presence of retinopathy, but insulin daily requirements were smaller when CP was present.
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Affiliation(s)
- Fabiano Marcel Serfaty
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, RJ, Brasil.
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