İmmün Nedenli Tip 1 Diyabetli Çocuk ve Adölesanlarda Eşlik Eden Diğer Otoimmün Hastalıkların Sıklığının Saptanması, Otoimmun Hastalığı Olan ve Olmayan Diyabetlilerin Kemik Mineral Yoğunluğunun Karşılaştırılması

Abstract

Yaman Ortakoylu, M. Determination of the Frequency of Other Autoimmune Diseases in Children and Adolescents With Immune Mediated Type 1 Diabetes and Comparison of Bone Mineral Density of diabetic patients With and Without Autoimmune Disease. Hacettepe University Faculty of Medicine, Thesis in Pediatrics, Ankara, 2019. Autoimmune destruction of beta cells is present in 90-95% of patients with type 1 diabetes. People with type 1 diabetes are at high risk of developing autoimmune and other diseases such as chronic autoimmune thyroiditis, celiac disease, autoimmune gastritis, autoimmune hepatitis and vitiligo. The association of diabetes and osteoporosis is frequently discussed in the literatüre. There are studies showing decreased bone mineral density in children and adolescents with type 1 diabetes. Microvascular complications or comorbidities such as celiac disease are known to adversely affect bone health in patients with type 1 diabetes. However, there are no comprehensive studies showing the effects of the presence of celiac disease and chronic autoimmune thyroiditis in children and adolescents with diabetes. The aim of this study is detection of autoimmune diseases associated with diabetes of children and adolescents who were followed up with the diagnosis of type 1 diabetes and at least one diabetes autoantibody positive in diagnosis and follow-up in the pediatric endocrinology department of our hospital between January 2004 and October 2018 and in addition comparison of bone mineral density of diabetic patients with and without celiac disease and chronic otoimmune thyroiditis. 639 patients with type 1 diabetes were included in the study. Gender, height and body weight, height standard deviation score, body mass index and z score, diabetes diagnosis age, duration of follow up with the diagnosis of diabetes, diabetes specific autoantibody positivity which detected during diabetes diagnosis or follow-up, HbA1c level in the diagnosis of diabetes, HbA1c average during the follow-up period in our hospital, microvascular complications and other accompanying autoimmune diseases of diabetic patients were recorded. Lumbar BMD was measured in 50 patients with diabetes (group 1), 10 patients with diabetes and vii chronic autoimmune thyroiditis (group 2), 14 patients with diabetes and celiac disease (group 3) and 2 patients with diabetes, chronic autoimmune thyroiditis and celiac disease. The mean age at diagnosis with diabetes was 7,93 ± 4,0 years. The mean follow-up period of diabetic patients was 3,92 ± 3,7 years and female/male was 1,04. No significant peaks were observed in the distribution of age at diagnosis of diabetes and it was observed that the plateau was present between the ages of 2-12 years. Nephropathy was found in 7,5% of the patients with diabetes. Autoimmune disease associated with diabetes was present in 18,8% of the cases. The male/female ratio of diabetic patients with autoimmune disease was 1,55. Chronic autoimmune thyroiditis in 12,5%, celiac disease in 5,9%, vitiligo in 1,3% of diabetic patients, Graves disease, autoimmune hepatitis and autoimmune gastritis/pernicious anemia in one case (0,15%) were detected. Two patients had both celiac disease and chronic autoimmune thyroiditis. Four of the diabetic patients had Down syndrome an done had Turner syndrome. There was no statistically significant difference between the mean total z-scores of Lumbar BMD in group 1, group 2 and group 3. The mean Lumbar BMD total z score was significantly lower in patients with diabetes follow-up ≥4 years than those with diabetes follow up <4 years. As a result; in this study, the presence of autoimmune diseases associated with type 1 diabetes was similar to other studies. There was no significant difference between the mean total z-scores of Lumbar BMD in patients with and without autoimmune disease at examined age group and duration of diabetes. However, due to the limited number of cases evaluated for Lumbar BMD in our study group, there is a need for extensive studies with more cases involving matched groups with similar age, sex, puberty stage and glycemic controls. Key words: Type 1 diabetes, children, adolescents, autoimmune diseases, bone mineral density