IDF21-0185 Prevalence of autoimmune diseases in young patients with type 1 diabetes

Abstract

Background: Autoimmunity and viral infections are the main etiopathological factors implicated in the pathogenesis of T1DM on the background of genetic predisposition. Type 1 diabetes mellitus (T1DM) is associated with various autoimmune disorders like celiac disease, thyroid disorder, adrenal failure, etc. However, how common is this association in Indian children is not clearly known. Aim: This cross-sectional study was planned to investigate the prevalence of autoimmune disorders like autoimmune thyroid disorders, celiac disease, and other autoimmune disorders in T1DM. Method: In this cross-sectional study, patients requiring insulin and ketosis-prone diabetic and with history of diabetic ketoacidosis/undetectable fasting C-peptide levels were included. Beside demographic and clinical data, detailed biochemistry evaluations were performed. Celiac disease was diagnosed as per the ESPGHAN diagnostic criteria. ACTH stimulation test was done to confirm the adrenal insufficiency in patients with basal serum cortisol <5 μg/dL. Thyroid function test (TSH) and anti-TPO antibody were assessed in all patients. Screening for other autoimmune disorders was done only when clinically indicated or symptoms or family history was suggestive of presence of such disorder. Results: Among 200 patients enrolled, 65% were males and mean age was 12.37 ± 3.34 years. Mean age at diagnosis of T1DM was 10.1 ± 3.58 years and duration of diabetes was 3.52 ± 3.21 years. The prevalence of antibodies positive against autoimmune diseases was anti-tTG IgA (21%), anti-TPO (34%), anti-CCP ab (1.5%), and ANA (0.8%). Significantly higher proportion of females had raised anti-TPO antibodies than males (48.1% vs. 26.4%, P = 0.005). Celiac disease was most common association (25.4%) followed by hypothyroidism (13.8%) and Grave's disease (3.2%). Significantly higher proportion of females had hypothyroidism than males (26.1% vs. 8.6%, respectively, P = 0.006). Prevalence of raised anti-tTG and anti-TPO did not differ significantly by the age (P = 0.841 and P = 0.067) or duration of T1DM (P = 0.493 and P = 0.399). Discussion: In this part of country, celiac disease, hypothyroidism, and Graves's disease are common associations in children with T1DM. This study also emphasizes the importance of total IgA estimation and duodenal biopsy in IgA anti-tTG-negative patients having strong suspicion of celiac disease on the basis of history. This study reinforces a call to improve the quality of healthcare services, including implementation of universal screening for thyroid dysfunction and celiac disease in children with T1DM.