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The Prevalence of Autoimmune Diseases in Longstanding Diabetes: Results from the Canadian Study of Longevity in Adults with Type 1 Diabetes

Published:October 27, 2020DOI:https://doi.org/10.1016/j.jcjd.2020.10.010

      Abstract

      Objective

      We aimed to determine the prevalence of autoimmune diseases (e.g. thyroid disease, celiac disease, etc) in Canadians with longstanding type 1 diabetes (T1D) and to explore sex-specific differences and the association with complications.

      Methods

      Cross-sectional data were analyzed in an exploratory secondary analysis from the Canadian Study of Longevity in Type 1 Diabetes, a nationwide registry of people with T1D of at least 50 years’ duration. In total, 374 participants provided self-reported questionnaire data and physician-reported laboratory results. Student’s t-test, the Wilcoxon rank-sum test, the χ2 test and logistic regression were used to identify associations with autoimmune diseases.

      Results

      The 374 participants had a median T1D duration of 53 years (interquartile range, 51 to 58) and a median age of onset of 11 years (6 to 16), and 57.1% were females. Females had a greater prevalence of autoimmune diseases (60.6% vs 34.4%, p<0.001). Thyroid disease was most prevalent (41%, 153/374), especially in females (51.6% vs 26.9%), and the prevalence of 1 or more autoimmune disease was 49.3% (184/374). Autoimmune disease was associated with lower odds of cardiovascular disease (CVD)—odds ratio [OR] 0.61, 95% confidence interval [CI] 0.37 to 1.00 for thyroid autoimmune disease and OR 0.34 (95% CI 0.12 to 0.93) for nonthyroid autoimmune disease, both compared to those without autoimmune disease (p=0.033). Autoimmune diseases were not associated with the presence of nephropathy, neuropathy or retinopathy.

      Conclusions

      Lifetime risk of autoimmune disease in longstanding T1D approaches 50%, is greater in females and is driven by thyroid disease. The probability of diabetes complications, such as CVD, was lower in those with autoimmune disease, which was driven mostly by nonthyroid autoimmune diseases.

      Résumé

      Objectif

      Nous avons pour objet de déterminer la prévalence des maladies auto-immunes (p. ex. la maladie thyroïdienne, la maladie cœliaque, etc.) au sein des Canadiens atteints depuis longtemps du diabète de type 1 (DT1) et d’examiner les différences entre les sexes et leur association avec les complications.

      Méthodes

      Nous avons analysé les données transversales dans une étude secondaire exploratoire de l’Étude canadienne sur la longévité et le diabète, un registre national de personnes atteintes du DT1 depuis au moins 50 années. Au total, 374 participants ont fourni par le biais d’un questionnaire leurs propres données et leurs résultats de laboratoire transmis par leur médecin. Nous avons utilisé le test de Student, le test de la somme des rangs de Wilcoxon, le test du χ2 t la régression logistique pour déterminer les associations avec les maladies auto-immunes.

      Résultats

      Les 374 participants avaient une durée médiane du DT1 de 53 ans (écart interquartile, de 51 à 58) et un âge médian de 11 ans (de 6 à 16) lors de son apparition, et 57,1 % étaient des femmes. La prévalence des maladies auto-immunes était plus grande (60,6 % vs 34,4 %, p < 0,001) chez les femmes. La prévalence de la maladie thyroïdienne était plus grande (41 %, 153/374), particulièrement chez les femmes (51,6 % vs 26,9 %), et la prévalence de 1 maladie auto-immune ou plus était de 49,3 % (184/374). La maladie auto-immune était associée à une plus faible probabilité de maladies cardiovasculaires (MCV, ratio d’incidence approché [RIA] 0,61, intervalle de confiance [IC] à 95 %, de 0,37 à 1,00 pour la maladie auto-immune de la thyroïde et RIA 0,34 [IC à 95 %, de 0,12 à 0,93] pour la maladie auto-immune autre que la maladie thyroïdienne, les 2 par rapport à ceux qui n’avaient pas de maladie auto-immune [p = 0,033]). Les maladies auto-immunes n’étaient pas associées à la présence d’une néphropathie, d’une neuropathie ou d’une rétinopathie.

      Conclusions

      Le risque à vie de maladies auto-immunes lors de DT1 de longue date frôle 50 %, est plus grand chez les femmes et est dominé par la maladie thyroïdienne. La probabilité de complications liées au diabète telles que les MCV était plus faible chez ceux qui avaient une maladie auto-immune, surtout chez ceux qui avaient une maladie auto-immune autre que la maladie thyroïdienne.

      Keywords

      Mots clés

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      Linked Article

      • In This Issue—A Highlight on the Use of Diabetes Registries
        Canadian Journal of DiabetesVol. 45Issue 6
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          In this issue Warncke et al (1) report the long-term outcomes of a rare, autosomal form of diabetes—thiamine-responsive megaloblastic anemia-related diabetes (TRMA). The authors aimed to characterize the clinical presentation and outcomes of this disorder and they hypothesized that early thiamine supplementation would result in improved glycemic control. Case reports had previously identified the potential for improving diabetes outcomes with early thiamine supplementation, requiring confirmation or refutation in a larger sample.
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