medwireNews: Almost one in five young people with type 1 diabetes develop another autoimmune disease, most commonly celiac or thyroid disease, within 20 years of diagnosis, show data from a Swedish registry-based study.
“Awareness of the high risk of developing other autoimmune diseases, and screening for these, is important from the onset of type 1 diabetes in children in order to commence treatment of autoimmune comorbidity at an early stage of disease,” say John Samuelsson (Linköping University) and co-investigators.
Between 2000 and 2019, the researchers found that 19.2% of 15,188 individuals with type 1 diabetes (mean age 9.5 years at onset, 45% female), who were added to the Swedish National Diabetes Register before 18 years of age, were diagnosed with at least one autoimmune disease.
By comparison, 4.0% of 74,210 individuals from the Swedish population, matched by age, sex and county, developed an autoimmune disease during the same period.
Individuals with diabetes who developed an autoimmune disease had a longer mean duration of type 1 diabetes at the end of follow-up than those with no autoimmune disease (mean 10.5 vs 8.5 years) and were slightly younger at diabetes onset (mean 9.2 vs 9.5 years). But there was no difference between the two groups in BMI (18.3 vs 18.6 kg/m2) or glycated hemoglobin level (6.6 vs 6.5%; 48.2 vs 47.6 mmol/mol) at 3 months to 1 year after diabetes onset.
Samuelsson et al report in Diabetologia that celiac disease was the most common additional autoimmune disease recorded in individuals with type 1 diabetes at the end of follow-up, with a prevalence of 10.6%.
This was followed by thyroid disease (7.1%), psoriasis (0.9%), vitiligo (0.7%), rheumatic joint disease (0.7%), inflammatory bowel disease (0.6%), systemic connective tissue disorders (0.5%), uveitis (0.4%), Addison’s disease (0.2%), and multiple sclerosis, inflammatory liver disease, and atrophic gastritis (all 0.1%).
Further analysis showed that the development of celiac disease was significantly associated with the age at type 1 diabetes onset, with nearly 20% of children in the youngest age group (0–4 years) being diagnosed.
Samuelsson and co-authors comment: “Screening for coeliac disease is of utmost importance within the first 5 years after type 1 diabetes onset since most cases are diagnosed during this period.” However, they also point out that some children diagnosed with type 1 diabetes between 0 and 4 years of age were diagnosed with celiac disease after up to 15 years of diabetes duration, “suggesting the necessity for considering a screening period longer than 5 years.”
The investigators also calculated the hazard ratios (HRs) for developing each of the comorbidities within 19 years from onset of type 1 diabetes. They found that the highest risk among the people with type 1 diabetes relative to those without diabetes was for atrophic gastritis, at a significant HR of 19.6. Significantly increased risks were also seen for Addison’s disease (HR=18.3), celiac disease (HR=11.6), thyroid disease (HR=10.6), inflammatory liver disease (HR=3.7), vitiligo (HR=4.1), rheumatic joint disease (HR=1.7), uveitis (HR=1.4), and psoriasis (HR=1.3).
The risks for inflammatory bowel disease, systemic connective tissue disorder, and multiple sclerosis did not differ significantly between the people with and without diabetes.
Despite individuals with type 1 diabetes having high rates of autoimmune disease, the development of these comorbidities had no statistically significant effect on glucose control or mortality risk.
“To our knowledge, this is the first comprehensive study where young individuals with type 1 diabetes were followed regarding development of a wide spectrum of autoimmune diseases, from onset of type 1 diabetes,” Samuelsson and colleagues remark.
They conclude: “Future studies should aim to provide a more detailed description of each [autoimmune disease] associated with an elevated risk in the type 1 diabetes population.”
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