A Study to Assess Type 1 Diabetes-Associated Disorders; Single Center Experience

Abstract

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in pediatric patients. The incidence of T1DM among children is rising worldwide. The overall annual increase is estimated at 3% with approximately 70,000 children worldwide expected to develop T1DM every year. Patients with T1DM are at high risk of developing other autoimmune diseases, such as autoimmune thyroiditis (AIT) and celiac disease (CD) Moreover, T1DM can lead to numerous complications in pediatric patients. Autoimmune thyroid disease (AITD) is the most frequent autoimmune disease associated with type 1 diabetes mellitus. The prevalence of thyroid autoantibodies in children with type I DM varies between 3% and 50% in different countries. Progression to overt thyroid disorders in individuals with significant titers of anti- TPO occurs in about 50% of them within 3-4 years. So, serological screening for autoimmune thyroid disease should be performed in all T1DM patients by means of antibodies at  Summary 147 T1DM onset and thereafter every second year according to ISPAD recommendations. The study aimed to co-relate the presence of Antiinsulin Antibody and / or Anti -thyroid Antibodies (Anti- TPO and/or Anti-TG) in type 1 diabetic patients regularly attending the pediatric diabetes clinic at Ain Shams University with the short and long term complications. It was conducted in the period from October 1st 2013 till June 4th 2014 and included 151 children and adolescents with type 1 DM, who were regularly followed up in the clinic, they were 73 males (48.3%) and 78 females (51.7%), their ages ranged from 2 -17 years with mean age 10.963.95 years and their disease duration ranged from 0.1- 16 years with mean of 3.84 3.41 year. All patients were subjected to: full history taking, thorough clinical examination and laboratory investigation including: HbAc1%, Serum Anti insulin Antibody, Anti TPO Antibody and Anti-TG Antibody. The results of the study showed: - Percentage of female patients in the study was slightly higher than males. - Almost forty percent (39.7%) of our studied population had family history of Diabetes whether type 1 or type 2.  Summary 148 - Eleven patients (7.3%) had family history of other autoimmune diseases. While only 2 patients (1.3%) were found to have other autoimmune diseases than type 1 diabetes. As for symptoms suggestive of autoimmune thyroid disease; the most common symptoms encountered were nervousness and heat or cold intolerance. - Only 1.3% (2/151) of patients was below the 5th centile for weight, whereas 9.3% (14/151) were short. - Three patients of 151 (2%) were hypertensive. - Thirty patients of out the total group of 151 diabetics had one or more microvascular complications. - About three quarters were poorly controlled. Due to sampling error, 128 patients out of our total number of patients (151) were serologically screened for the presence of Anti-insulin Antibodies and Anti-Thyroid Antibodies. - Fifty three (53) patients out of (128) were positive for Anti-insulin Antibody giving a sero-positivity of 41.4%, whereas 13 patients (10.2%) displayed positive results for Anti-Thyroid Antibodies, all of them were positive only for TPO-Ab, 0% was positive for TG-Ab and 4.7% (6/128) were positive for both anti-insulin and anti-TPO antibodies.  Summary 149 - No relation was found between positivity of Anti-insulin antibodies and Anti-TPO antibody titre. - There was no significant difference in age, gender or age of onset as regard positivity to any of the antibodies. - There was significant relation between Anti-TPO antibody positivity and duration of diabetes. , the majority of anti-TPO-positive patients (61.5%) had less than 5 years of diabetes, (15.4%) between 5 and 10 years, and (23.1%) more than 10 years (p=0.053). - Frequency of diabetics receiving an insulin dose between 1-2 IU/Kg/day was higher among those expressing Anti- insulin Antibody positivity. Lower insulin requirements were observed among those with negative Anti- insulin Antibody even though there was no significant relation between insulin requirements and Anti-TPO positivity (p- value>0.05).