Haydarpasa Numune Med J. 2021; 61(3): 346-351 | DOI: 10.14744/hnhj.2019.59852

Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-Center Experience

Seher Tanrýkulu¹, Gülþah Yenidünya Yalýn², Ramazan Çakmak³, Sakin Tekin⁴, Hülya Hacýþahinoðullarý², Nurdan Gül², Özlem Soyluk Selçukbiricik², Ayþe Kubat Uzum², Yýldýz Tütüncü², Kubilay Karþýdað², Nevin Dinççað², Mehmet Temel Yýlmaz², Ilhan Satman^2
1Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Health Sciences Turkey, Haydarpasa Numune Health Application and Research Center, Istanbul, Turkey
²Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
³Department of Internal Medicine, Division of Endocrinology and Metabolism, Baþakþehir Çam ve Sakura City Hospital, Istanbul,Turkey
⁴Department of Internal Medicine, Division of Endocrinology and Metabolism, Zonguldak Bülent Ecevit University, Zonguldak, Turkey

INTRODUCTION: Diabetes guidelines recommend routine screening for autoimmune thyroid disease (ATD) and celiac disease, especially in cases of childhood-onset type 1 diabetes (T1D). However, level of evidence is weak (expert opinion), and for adult-onset T1D even less clear. The aim of this study is to evaluate the prevalence of comorbid autoimmune diseases (ADs) in childhood-onset and adult-onset T1D patients, and to compare distribution of individual ADs with those with T2D.
METHODS: Among a total of 1594 adult diabetes patients who were consecutively followed by a single Diabetes Center, 22%(n=351) had T1D. Patients with T1D were screened for ATD, pernicious anemia, vitiligo, celiac, and when clinically relevant for Addison’s, and other organ-specific/systemic autoimmune/autoinflammatory diseases. To compare distribution of ADs we included a group of 50 T2D patients with at least one known autoimmunity. Additionally, relationship between ADs, level of glycemic control, presence of micro-and macrovascular complications were investigated.
RESULTS: The prevalence of AD was 26.2% in T1D with females being more affected than males. ATD was the most prevalent, followed by pernicious anemia, vitiligo, celiac, and premature gonadal failure. Over 60% had single (mostly ATD; T1D 83.6%, T2D 68.6%), and over 20% had double AD with no significant difference between T1D and T2D. Of T1D patients, 8.2% had triple AD. The majority of ATDs was Hashimoto’s thyroiditis and/or hypothyroidism, only 12% had Graves’ disease (T1D 10.9%, and T2D 14%). In T1D women, pernicious anemia (22.8%), vitiligo (9.8%), and celiac (8.7%) were the most common comorbidities of ATD. There was no significant relationship between the frequency of ADs and individual ADs and glycemic control, age-at-onset of diabetes, and micro-and macrovascular complications.
DISCUSSION AND CONCLUSION: Screening for ATD should be included in routine management protocol of adult-onset T1D as recommended in those with childhood-onset. Furthermore, we suggest investigation for pernicious anemia, vitiligo, and celiac disease in women with T1D.

Keywords: type 1 diabetes mellitus, type 2 diabetes mellitus, autoimmune disease, autoimmune thyroid disease, celiac disease, Addison, vitiligo

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Tip 1 ve Tip 2 Diabette görülen otoimmün hastalýklar: Tek merkez deneyimi

Seher Tanrýkulu¹, Gülþah Yenidünya Yalýn², Ramazan Çakmak³, Sakin Tekin⁴, Hülya Hacýþahinoðullarý², Nurdan Gül², Özlem Soyluk Selçukbiricik², Ayþe Kubat Uzum², Yýldýz Tütüncü², Kubilay Karþýdað², Nevin Dinççað², Mehmet Temel Yýlmaz², Ilhan Satman^2
1Saðlýk Bilimleri Üniversitesi, Haydarpaþa Numune Eðitim ve Araþtýrma Hasstanesi, Ýç Hastalýklarý ABD, Endokrinoloji ve Metabolizma Hastalýklarý Kliniði, Ýstanbul
²Ýstanbul Üniversitesi, Ýstanbul Týp Fakültesi, Ýç Hastalýklarý ABD, Endokrinoloji ve Metabolizma Hastalýklarý BD, Ýstanbul
³Baþakþehir Çam ve Sakura Þehir Hastanesi, Ýç Hastalýklarý Endokrinoloji ve Metabolizma Hastalýklarý Kliniði, Ýstanbul
⁴Zonguldak Bülent Ecevit Üniversitesi, Ýç Hastalýklarý ABD, Endokrinoloji ve Metabolizma Hastalýklarý BD, Zonguldak

GÝRÝÞ ve AMAÇ: Diyabet kýlavuzlarý özellikle çocukluk çaðý baþlangýçlý Tip 1 diyabette (T1D) otoimmün tiroid hastalýðý (OÝT) ve çölyak hastalýðý taramasý önermektedir. Bu konudaki kanýtlar zayýf (uzman düzeyinde) olmakla birlikle eriþkin baþlangýçlý T1D'te veriler daha kýsýtlýdýr. Bu çalýþmanýn amacý, çocukluk çaðý ve eriþkin baþlangýçlý T1D'li hastalarda eþlik eden OH'lerin prevalansýný belirlemek, OH'lerin daðýlýmýný T2D olan hastalarla karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Tek bir merkezde takip edilen ardýþýk 1594 yetiþkin diyabet hastasýnýn %22'sinde (n=351) T1D mevcuttu. T1D'li hastalar otoimmün tiroid hastalýðý, pernisiyöz anemi, vitiligo, çölyak, Addison ve diðer organa özgü/sistemik otoimmün/inflamatuar hastalýklar için tarandý.
T1D olan bireylerdeki OH'lerin daðýlýmýný karþýlaþtýrmak için otoimmünitesi olduðu bilinen 50 T2D hastasý çalýþmaya dahil edildi. Ayrýca glisemik kontrol düzeyi ve komplikasyonlarýn daðýlýmý deðerlendirildi.
BULGULAR: Otoimmün hastalýk prevalansý T1D'de %26.2 idi ve kadýnlar erkeklerden daha fazla etkileniyordu. Otoimmün tiroid hastalýðý en yaygýn görülen OH olup, bunu pernisiyöz anemi, vitiligo, çölyak ve erken gonadal yetmezlik izledi. Hastalarýn %60'ýnýn üzerinde tek OH mevcutken (çoðunlukla otoimmün tiroid hastalýðý; T1D %83,6, T2D %68,6), %20'den fazla hastada iki adet eþlik eden OH vardý. T1D olan hastalarýn %8.2'sinde üç adet eþlik eden OH mmevcuttu. Otoimmün tiroid hastalarýnýn çoðunda Hashimoto tiroiditi ve/veya hipotiroidi mevcutken, sadece %12'sinde Graves hastalýðý vardý (T1D %10.9 ve T2D %14). T1D kadýnlarda pernisiyöz anemi (%22.8), vitiligo (%9.8) ve çölyak (%8.7) otoimmün tiroid hastalýðýna eþlik eden en sýk komorbiditelerdi. Otoimmün hastalýk, hastalýk baþlangýç zaman glisemik kontrol, ve komplikasyon oranlarý arasýnda anlamlý bir fark saptanmamýþtýr.
TARTIÞMA ve SONUÇ: Otoimmün tiroid hastalýðý taramasý, çocukluk çaðý baþlangýçlý T1D önerildiði gibi eriþkin baþlangýçlý T1D'nin rutin programýnda da düþünülmelidir. Ayrýca, T1D'li kadýnlar eþlik edebilecek pernisiyöz anemi, vitiligo ve çölyak hastalýðý için deðerlendirilmelidir.

Anahtar Kelimeler: tip 1 diabetes mellitus, tip 2 diabetes mellitus, otoimmün hastalýk, çölyak, otoimmün tiroid hastalýðý, Addison hastalýðý, vitiligo

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