Introduction: Type 1 diabetes (T1DM) is an autoimmune disease with abnormal immune responses to specific β-cell autoantigens, resulting in insulin deficiency. Children and adolescents with T1DM may also develop organ-specific autoimmunity. The most frequently reported disorders are thyroid dysfunction and celiac disease. There are limited previous studies on the prevalence of associated autoimmunity, especially multiple, in children with T1DM.
Aim: The present study reports the prevalence of prevalence autoantibodies and thyroid dysfunction in a cohort of children with T1DM and T2DM.
Patients and methods: This was a cross sectional descriptive study to determine the prevalence of beta cell autoimmunity (Anti GAD, anti-islet cell and anti-insulin antibodies), thyroid function (Free thyroxine (FT4) and TSH) and anti-thyroid peroxidase antibody (ATPO) and anti-tissue transglutaminase (ATT) in a cohort of children and adolescent (aged 6 months-16 years) with T1DM (n=431) and T2DM (n=59) checked at their first presentation at Hamad General Hospital pediatric Diabetes Center, Doha, Qatar over 5 years period from 2012 2016.
Results: The prevalence of anti-GAD antibodies=75.5% in T1DM and 29.3% in T2DM. Anti-islet Ab were detected in 53.4% of T1DM and 29.4% of T2DM. Anti-insulin AB was detected in 40.4% of T1DM and 58.3% of T2DM. The three antibodies together were high in 18.4% of T1DM and none of T2DM. Anti TPO was detected in 27.2% of T1DM and 34.6% of T2DM. Hypothyroidism (FT4<11.5) was detected in 10.6% of T1DM and 10% of T2DM. Subclinical hypothyroidism was diagnosed in 3.5% of T1DM and 8% of T2DM. High anti-TPO was detected in 27.2% of T1DM and 34.6% of T2DM. 22.7% of T1DM and 23.1% of T2DM had high anti-TPO with normal thyroid function. ATT IgA was high in 5% of T1DM and 8.7% of T2DM whereas ATT IgG was high in 4.4% of T1DM and not detected in any patient with T2DM. Mucosal biopsy proved the diagnosis of celiac disease in 9 out of 12 patients with positive ATT IgA and IgG antibodies.
Conclusion: We report a high prevalence of associated autoimmune abnormalities in our patients with T1DM and T2DM. These data strengthen the argument for routine screening of all children and adolescents with T1DM and T2DM for other autoimmune disorders particularly the thyroid function and increased anti-TPO and ATT antibodies.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology