SAT-378 Thyroid Disease, a Severe Infection, and Glucagon Prescription Should Raise the Awareness of Addison's Disease in Patients with Type 1 Diabetes: A National Swedish Study

Abstract

Background: Patients with type 1 diabetes mellitus (T1DM) have an increased risk of Addison's disease (AD) (1), and recognizing those at risk would be of great value. Objective: To determine if there are early clinical indicators that may denote the development AD in adult patients with T1DM. Methods: Nationwide, matched, observational cohort study linking data from Swedish national registries [among others National Diabetes Register (NDR), Inpatient Register and Prescribed Drug Register] with a coverage of >97%. Patients with T1DM who developed AD (cases) were matched to 5 control subjects with T1DM that did not develop AD. Clinical data (including co-morbidities) and drug prescriptions were assessed: a) prior to baseline (inclusion into the study), and b) 2 years prior to AD diagnosis. Analysis of covariance and estimated group proportions, with corresponding 95% confidence intervals (CI), were used for comparisons between groups. Results: Between 1998-2013 and among 36,514 adult patients with T1DM in NDR, 66 patients were diagnosed with concomitant AD. These cases were matched to 330 controls with T1DM. Prior to baseline, cases had higher proportion of prescription of thyroid/anti-thyroid drugs than controls (9.1% vs 1.8%). Prior to AD diagnosis, cases compared with controls had higher proportion of diabetic retinopathy (12.1% vs 2.1%), infections requiring hospital admission (16.7% vs 2.1%), higher frequency in prescription of thyroid/anti-thyroid drugs (28.8% vs 7.0%), and prescription of glucagon (18.2% vs 6.4%). No difference in HbA1c (glycated haemoglobin) was seen between the groups prior to baseline or prior to AD diagnosis. Conclusions: These population-based, nation-wide, real-world data suggest that medical treatment for thyroid disease, a severe infection and prescription of glucagon for hypoglycemia should raise the awareness of AD in adult patients with T1DM. Our data also suggest that the development of diabetic retinopathy could also be associated with glucocorticoid deficiency prior to the development of AD. Reference: (1) Chantzichristos D et al. Eur J Endocrinol. 2018;178(1):115-122. Disclosure statement: The authors have nothing to disclose. Funding: The National Diabetes Registry receives financial support from the Swedish Association of Local Authorities and Regions and the Region Västra Götaland. The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-719531) and the Swedish Research Council (2015-02561). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.