Correlation between auto-immune diseases and type 1 diabetes mellitus in the pediatric age group in Erbil city

Authors

  • Lana Ahmed Mohammed Department of Paediatrics, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Yousif Baha’addin Ahmed Department of Internal medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2024.009

Keywords:

Diabetes mellitus, Autoimmune diseases, Overt hypothyroidism

Abstract

Background and objective: Type-1 diabetes mellitus is the most common chronic endocrine disorder of childhood and adolescence and is characterized by immune-mediated destruction of pancreatic cells, which has been proven to be correlated with and increase the risk of developing autoimmune thyroid disease, celiac disease, Addison’s disease, and further autoimmune diseases. The aim of this study is to evaluate the prevalence of autoimmune disease-related markers in type 1 diabetes mellitus in children and adolescents in Erbil city.

Methods: One hundred children and adolescents with type 1 diabetes mellitus were enrolled in this cross-sectional study. Patients <1 year old were excluded from the study. Autoimmune thyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) along with tissue transglutaminase (IgA and IgG) antibodies were measured with further evaluation by thyroid function test and endoscopy with biopsy (for positive serological autoantibodies level).

Results: Elevated anti-thyroglobulin, anti-thyroid peroxidase, and tissue transglutaminase IgA and IgG antibodies were determined in 24.0%, 26%, 10%, and 8%, respectively. 50.0% of cases with positive anti-thyroid peroxidase antibodies had overt hypothyroidism; on the flip side, 3.8% had subclinical hypothyroidism. As well, the high level of thyroid autoantibodies was significantly correlated to the prevalence of overt hypothyroidism (P <0.001). Nine of the patients with positive tissue transglutaminase antibodies were verified to have biopsy-proven celiac disease.

Conclusion: Children and adolescents with type 1 diabetes mellitus are at risk of developing positive antithyroid and celiac-related autoantibodies, so they are at risk of progressing to autoimmune thyroid and celiac diseases.

Metrics

Metrics Loading ...

References

Ozen G, Zanfardino A, Confetto S, Piscopo A, Casaburo F, Tinto N et al. The Association of Autoimmune Diseases with Type 1 Diabetes Mellitus in Children Depends Also by the Length of Partial Clinical Remission Phase (Honeymoon). Int J Endocrinol 2020; 2020:2630827. DOI:10.1155/2020/2630827.

Krzewska A, Ben-Skowronek I. Effect of Associated Autoimmune Diseases on Type 1 Diabetes Mellitus Incidence and Metabolic Control in Children and Adolescents. Biomed Res Int 2016; 2016:6219730. DOI:10.1155/2016/6219730.

Szalecki M, Wysocka-Mincewicz M, Ramotowska A, Mazur A, Lisowicz L, Beń-Skowronek I, et al. Epidemiology of type 1 diabetes in Polish children: A multicentre cohort study. Diabetes Metab Res Rev 2018; 34(2). DOI:10.1002/dmrr.2962.

Camilo DS, Pradella F, Paulino MF, Baracat ECE, Marini SH, Guerra G Jr et al. Partial remission in Brazilian children and adolescents with type 1 diabetes. Association with a haplotype of class II human leukocyte antigen and synthesis of autoantibodies. Pediatr Diabetes 2020; 21(4):606-14. DOI:10.1111/pedi.12999.

Zhong T, Tang R, Gong S, Li J, Li X, Zhou Z. The remission phase in type 1 diabetes: Changing epidemiology, definitions, and emerging immuno-metabolic mechanisms. Diabetes Metab Res Rev 2020; 36(2):e3207. DOI:10.1002/dmrr.3207.

Winter WE, Schatz DA. Autoimmune markers in diabetes. Clin Chem 2011; 57(2):168–75. DOI:10.1373/clinchem.2010.148205.

Li L, Liu S, Yu J. Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective? Ther Adv Endocrinol Metab 2020; 11:2042018820958329. DOI:10.1177/2042018820958329.

Głowińska-Olszewska B, Szabłowski M, Panas P, Żoła Dek K, Jamiołkowska-Sztabkowska M, Milewska AJ et al. Increasing Co-occurrence of Additional Autoimmune Disorders at Diabetes Type 1 Onset Among Children and Adolescents Diagnosed in Years 2010-2018-Single-Center Study. Front Endocrinol (Lausanne) 2020; 11:476. DOI:10.3389/fendo.2020.00476.

Camarca ME, Mozzillo E, Nugnes R, Zito E, Falco M, Fattorusso V et al. Celiac disease in type 1 diabetes mellitus. Ital J Pediatr 2012; 38:10. DOI:10.1186/1824-7288-38-10.

Kahaly GJ, Hansen MP. Type 1 diabetes associated autoimmunity. Autoimmun Rev 2016; 15(7):644–8. DOI:10.1016/j.autrev.2016.02.017.

Shaikh SB, Haji IM, Doddamani P, Rahman M. A Study of Autoimmune Polyglandular Syndrome (APS) in Patients with Type1 Diabetes Mellitus (T1DM) Followed Up at a Teritiary Care Hospital. J Clin Diagn Res 2014; 8(2):70-2. DOI:10.7860/jcdr/2014/7013.4011.

Minelli R, Gaiani F, Kayali S, Di Mario F, Fornaroli F, Leandro G et al. Thyroid and celiac disease in pediatric age: a literature review. Acta Biomed 2018; 89(9-S):11–6. DOI:10.23750/abm.v89i9-s.7872.

Riquetto ADC, de Noronha RM, Matsuo EM, Ishida EJ, Vaidergorn RE, Soares Filho MD et al. Thyroid function and autoimmunity in children and adolescents with Type 1 Diabetes Mellitus. Diabetes Res Clin Pract 2015; 110(1):e9–11. DOI:10.1016/j.diabres.2015.07.003.

Alves C, Santos LS, Toralles MB. Association of type 1 diabetes mellitus and autoimmune disorders in Brazilian children and adolescents. Indian J Endocrinol Metab 2016; 20(3):381–6. DOI:10.4103/2230-8210.179994.

Nederstigt C, Uitbeijerse BS, Janssen LGM, Corssmit EPM, de Koning EJP, Dekkers OM. Associated auto-immune disease in type 1 diabetes patients: a systematic review and meta-analysis. Eur J Endocrinol 2019; 180(2):135–44. DOI:10.1530/eje-18-0515.

Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmun Rev 2015; 14(9):781–97. DOI:10.1016/j.autrev.2015.05.002.

Ashok T, Patni N, Fatima M, Lamis A, Siddiqui SW. Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod. Cureus 2022; 14(6):e26243. DOI:10.7759/cureus.26243.

Mahmud FH, Elbarbary NS, Fröhlich-Reiterer E, Holl RW, Kordonouri O, Knip M et al. ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19(Suppl 27):275–86. DOI:10.1111/pedi.12740.

Gopal KV, Rao GR, Kumar YH. Increased prevalence of thyroid dysfunction and diabetes mellitus in Indian vitiligo patients: A case-control study. Indian Dermatol Online J 2014; 5(4):456–60. DOI:10.4103/2229-5178.142493.

Ridha MF, Al Zubaidi MA. Thyroid auto immune antibodies in children with Type-I Diabetes mellitus in relation to diabetes control. Pak J Med Sci 2019; 35(4):969–73. DOI:10.12669/pjms.35.4.192.

Degrandi R, Prodam F, Genoni G, Bellomo G, Bona G, Giordano M et al. The Prevalence of Thyroid Autoimmunity in Children with Developmental Dyslexia. Biomed Res Int 2021; 2021:7656843. DOI:10.1155/2021/7656843.

CerqueiroBybrant M, Udén E, Frederiksen F, Gustafsson AL, Arvidsson CG, Fureman AL et al. Celiac disease can be predicted by high levels of tissue transglutaminase antibodies in children and adolescents with type 1 diabetes. Pediatr Diabetes 2021; 22(3):417–24. DOI:10.1111/pedi.13165.

American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41(Suppl 1):S13-27. DOI:10.2337/dc18-s002.

Hage M, Zantout MS, Azar ST. Thyroid disorders and diabetes mellitus. J Thyroid Res 2011; 2011:439463. DOI:10.4061/2011/439463.

Hwang GB, Yoon JS, Park KJ, Lee HS, Hwang JS. Prevalence of autoimmune thyroiditis in patients with type 1 diabetes: a long-term follow-up study. Ann Pediatr Endocrinol Metab 2018; 23(1):33–7. DOI:10.6065/apem.2018.23.1.33.

Jonsdottir B, Larsson C, Lundgren M, Ramelius A, Jönsson I, Larsson HE; DiPiS study Group. Childhood thyroid autoimmunity and relation to islet autoantibodies in children at risk for type 1 diabetes in the diabetes prediction in skåne (DiPiS) study. Autoimmunity 2018; 51(5):228–37. DOI:10.1080/08916934.2018.1519027.

Ardestani SK, Keshteli AH, Khalili N, Hashemipour M, Barekatain R. Thyroid disorders in children and adolescents with type 1 diabetes mellitus in isfahan, iran. Iran J Pediatr 2011; 21(4):502–8. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3446149/

Tiberti C, Panimolle F, Bonamico M, Shashaj B, Filardi T, Lucantoni F, et al. IgA anti-transglutaminase autoantibodies at type 1 diabetes onset are less frequent in adult patients and are associated with a general celiac-specific lower immune response in comparison with nondiabetic celiac patients at diagnosis. Diabetes Care 2012; 35(10):2083–5. DOI:10.2337/dc11-2171.

Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020; 236(6):571–92. DOI:10.1159/000506103.

Marçon CR, Maia M. Albinism: epidemiology, genetics, cutaneous characterization, psychosocial factors. An Bras Dermatol 2019; 94(5):503–20. DOI:10.1016/j.abd.2019.09.023.

Downloads

Published

2024-04-24

How to Cite

Mohammed, L. A., & Ahmed, Y. B. . (2024). Correlation between auto-immune diseases and type 1 diabetes mellitus in the pediatric age group in Erbil city. Zanco Journal of Medical Sciences (Zanco J Med Sci), 28(1), 85–94. https://doi.org/10.15218/zjms.2024.009

Issue

Section

Original Articles