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Additional autoimmune disease found in one-third of patients with type 1 diabetes
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At diagnosis of type 1 diabetes, approximately 33% of patients are positive for at least one additional organ-specific autoantibody, according to new data.
Researchers at the Barbara Davis Center for Childhood Diabetes assessed 491 children diagnosed with type 1 diabetes from 2004 to 2009 for other autoimmune conditions. They measured thyroid peroxidase autoantibodies (TPOAb) to screen for autoimmune thyroid disease, tissue transglutaminase autoantibodies (TTGAb) for celiac disease and 21-hydroxylase autoantibodies (21OHAb) for Addison’s disease.
“We sought to define the prevalence of nonislet, organ-specific autoantibodies at the diagnosis of type 1 diabetes and to determine the prevalence of comorbid autoimmune diseases,” the researchers wrote.
Of the 491 children, 82.7% were white and 53.4% were boys. At the time of diagnosis with type 1 diabetes, mean age was 9.6 years and the average HbA1c level was 11.6%. Measurements of TPOAb, TTGAb and 21OHAb were collected within 16 days, on average, and patients were diagnosed with autoimmune thyroid disease, celiac disease or Addison’s disease within 45 days.
Overall, 32.6% of the children had at least one nonislet, organ-specific autoantibody. Of these, 18.6% were diagnosed with additional autoimmune disease. Results revealed that 24.8% were positive for TPOAb, of whom 12.3% had autoimmune thyroid disease. Of the 11.6% with TTGAb, 24.6% had celiac disease. Just 1% of children had 21OHAb, and the researchers found only one case of Addison’s disease.
“Ongoing follow-up of this cohort will be important to determine the natural history of organ-specific autoimmunity in patients with type 1 diabetes,” the researchers wrote. “Key questions remain, including the incidence of autoantibodies over time, the evolution from positive antibodies to disease, the genetic influences on autoimmunity and disease, and patient characteristics that may influence antibody or disease development.”
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Disclosure: The researchers report no relevant financial disclosures.
This is a very interesting paper looking at the antibody titers directed against other endocrine organs at the onset of type 1 diabetes. The high rates of antibodies indicating a suspicion for thyroid disease and celiac disease reinforce the current practice of carefully monitoring children and adolescents with diabetes for the development of these conditions. Intriguingly, the rates of antibodies directed against adrenal gland androgens raise the question of whether this should be routinely screened for at the time of diagnosis, and reminds us all that we need to be vigilant in monitoring our patients for Addison’s disease.
– Darrell Wilson, MD
Professor of Pediatrics, Stanford University Packard Children’s Hospital
Disclosure: Dr. Wilson reports on relevant disclosures.
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