October - December 2007, Volume 3, Issue 4

Reghina A, Macovei M, Martin S, Sirbu A, Barbu C, Bunghez R, Grigorescu M, Fica SV

Phenotypes of patients with type 1 diabetes mellitus and autoimmune diseases

Acta Endo (Buc) 2007, 3 (4): 451-460
doi: 10.4183/aeb.2007.451

Autoimmune diseases are a heterogeneous group that involves almost any tissue and organ, a patient could frequently present more than one autoimmune disease. Type 1 diabetes mellitus is frequently associated with other autoimmune diseases in polyglandular autoimmune syndrome. Aim of the study is to evaluate a phenotype of diabetic patients with autoimmune diseases. There is a retrospective study; we analyzed type 1 diabetes inpatients from our department in late 4 years based on clinical records. We state that type 1 diabetes mellitus diagnosis is established based on insulin treatment at onset or less than 1 year from onset. We analyzed the presence of the following autoimmune diseases: Graves’ disease, Hashimoto thyroiditis, autoimmune hypothyroidism, Addison’s disease, vitiligo, psoriasis, systemic lupus erythematosus, pernicious anemia. We recorded 151 patients with type 1 diabetes mellitus: 91 (60.3%) women. Mean age was 38.4?15.8 years, mean span of type 1 DM was 12 years, mean age at the onset of DM was 26.5 years, and mean BMI was 23.4 kg /m2. Patients were insulin treated with 2 doses of insulin 11.3%, 3 doses of insulin 41.6%, 4 doses of insulin 45%, and insulin pump 2%. 41 patients (27.2%) associated other autoimmune diseases, most frequently being chronic thyroiditis. Type 1 DM preceded autoimmune disease in 60%. Patients that associated autoimmune disease have mean age at the onset of type 1 DM 29.1 years. Mean glycated hemoglobin among patients with autoimmune diseases was 10.1% vs. 9.9% among patients without autoimmune diseases (NS); mean insulin needs were respectively 0.78 u/kgc vs. 0.72 u/kgc (NS). In conclusion, type 1 DM is frequently associated with other autoimmune diseases, patients being mainly women. The most frequent association is Graves’ disease. In over 50% of cases type 1 DM precedes autoimmune disease with several years. Even though more than half of patients were treated with multiple doses of insulin, glycated hemoglobin was high, slightly higher among patients with autoimmune diseases but the differences were not statistically significant.

Keywords: type 1 diabetes mellitus, autoimmune diseases, phenotype, glycemic control, chronic thyroiditis

Correspondence: Simona Fica, M.D, Elias Hospital, Marasti street, no 17, Bucharest, Romania & Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, phone: +4 021 3161614, fax: +4 021 3161614, e-mail: simonafica@yahoo.com