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Ann Pediatr Endocrinol Metab > Accepted Articles
DOI: https://doi.org/10.6065/apem.2142168.084    [Accepted] Published online November 15, 2021.
Predictors of associated and multiple autoimmunity in children and adolescents with type 1 diabetes mellitus (T1DM)
Konstantinos Kakleas1  , Lydia Kossyva1, Anastasia Korona1, Nikolitsa Kafassi2, Spyridon Karanasios1, Kyriaki Karavanaki1
1Diabetic Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, ‘P. & A. Kyriakou’ Children’s Hospital, Athens, Greece
2Department of Immunology, ‘Laiko’ General Hospital, Athens, Greece
Address for correspondence:  Konstantinos Kakleas
Email: koskakl2@yahoo.gr
Received: August 13, 2021   Revised: October 18, 2021   Accepted: November 1, 2021
Abstract
Purpose
Type 1 Diabetes mellitus (T1DM), is an autoimmune condition characterised by antipancreatic antibodies presence. Autoimmune process is also directed against other organs, most frequently against the thyroid gland, intestinal mucosa and the gastric parietal cells.
Methods
We have investigated in 121 children with T1DM and mean age ±SD of 11.99±4.63 years (range: 2.0-20.0) the frequency of associated autoimmunity and explored the presence of predictive factors, such as current age, sex, severity at diabetes diagnosis, T1DM duration and family history of autoimmunity.
Results
Associated autoimmunity was present in 28.9% of T1DM patients. Children with associated autoimmunity at diabetes diagnosis were older (p=0.009), and had longer diabetes duration, compared to children without associated autoimmunity (p=0.044). Adolescents with present age 12-20 years had statistically significant higher chance of developing thyroid autoimmunity compared to children aged 1-5 years (p = 0.019). Multiple autoimmunity (MA) (T1DM and >2 autoimmune diseases) was present in 5.8% of the study population. All children with MA presented with ketoacidosis at diabetes diagnosis. They also had higher percentage of familial autoimmunity (p = 0.042), had more frequently ≥ 3 relatives with autoimmunity (p=0.026) and were more frequently diagnosed before 5 years of age (p=NS).
Conclusions
Associated autoimmunity was present in almost one third of T1DM patients, with longer diabetes duration, female sex, older age at diabetes diagnosis and glutamic acid decarboxylase (GADA) positivity. Predictors of multiple autoimmunity were age at T1DM diagnosis < 5 years, diabetic ketoacidosis at diagnosis and the presence of a significant family history of autoimmunity.
Keywords: Type 1 diabetes mellitus; Child; Associated autoimmunity; Multiple autoimmunity; Predictors


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