Title : Association of Autoimmune Pathologies withType1 Diabetes: Epidemiological, clinical and metabolic aspects
Abstract:
Summary
The association of autoimmune dysthyroidism (AD) and/or celiac disease (CD) with type 1 diabetes (T1DM) are autoimmune diseases resulting from the interaction of genetic, immunological and environmental factors. These pathologies associated with diabetes can lead to disturbances in metabolic control and affect growth in diabetic children. The frequency of this association, which is often latent, is assessed in different ways.
Objectives: The aim of our study is to determine the prevalence of antithyroid peroxidase antibodies and dysthyroidism as well as the prevalence of CD at T1D. This on the one hand, and on the other, to study the impact of early Gluten Free Diet (GFD) on metabolic control and prognosis in children and young diabetics.
MaterialandMethods: 419 diabetic children and adolescents (209G and210 B),with a meanage of 13.5±5.9 years, were included in this exploratory study.These patients were regularly followed up at the pediatric diabetology consultation of the Rabat Children's Hospital.
The duration of their diabetes (mean: 5.5±4.8 years) and their metabolic control (HbA1c) assessed by ion-exchange chromatography. Thyroid hormones: free triiodothyronine (FT3), free thyroxine (FT4), Thyroid Stimulating Hormone (TSH) and anti-peroxidase antibodies (TPOAb) were measured by radioimmunoassay.
Results: 53 patients (12.64%) (53/419) were TPOAb positive (mean: 408.6 IU/L).Of these, 10 diabetics had dysthyroidism: 3 had hypothyroidism and 7 had hashimoto's thyroiditis.2 patients had hyperthyroidism. 366 diabetic children and adolescents had normal anti-TPOAb levels. Among these patients, 20 have latent hypothyroidism and 2 latent hyperthyroidism. Among our young type 1 diabetics, the prevalence of hypothyroidism is 7.17%, hashimoto's thyroiditis 1.56% and hyperthyroidism 0.89%. 49 T1D had celiac disease a few years (1-6 years) after the diagnosis of diabetes, with the exception of one patient who had celiac disease before the diagnosis of T1D.
The prevalence of CD was 1.6% (50/3000) in the T1DM population. 14 boys and 10 girls with T1DM, mean age 14.4. Age at diagnosis of T1DM was 4 years. Median age at diagnosis of CD was 8.5 years. The median age of onset of CD after diagnosis of T1DM is 2.5 years. 54.5% have moderate growth retardation (-1DS,-2DS) and 4.5% have severe growth retardation (-4DS).62.5%shownormal growth after follow-up (GFR). Major signs are frequent in celiac T1D: abdominal pain (57.5%), transit disorders (47.5%), abdominal swelling (45%) and mucocutaneous pallor (32.5%). Anti-endomysial, anti-transglutaminase and anti-gliadin antibodies were positive in 34%, 82.6% and 8.9% respectively. Histological examination showed total villous atrophy (TVA) in 56.4% (22/49),subtotal villous atrophy (STVA) in 10.3% (4/49), partial villous atrophy (PVA) in 28.2% (11/49). 93% (40/43) of patients were within GFR. Patients' metabolic control of HbA1c improved by 7.9% before GFR and by 7.8% (range: 6-10.3%) after taking the GFR.
Conclusion: In Morocco, the association of AT, CD and T1DM is not uncommon. This study confirms the frequency of autoimmune dysthyroidism and CD in diabetic children, and their often latent nature. Gluten-intolerant patients have to make do with the gluten-free diet. Strict adherence to this diet leads to a reduction in symptoms, recovery of the intestinal mucosa and also prevents the development of complications associated with celiac disease, such as cancer.
