Screenings for Autoimmune Diseases Necessary for Children, Adolescents With T1D

Current guidelines recommend screening for the 2 most commonly diagnosed autoimmune diseases among adolescent patients with type 1 diabetes, but researchers suggest that additional screenings could benefit patients.

The high incidence of additional autoimmunity in children and adolescents with type 1 diabetes (T1D) justifies regular screenings of additional autoantibodies and additional autoimmune diseases, according to a recent study.

Patients with T1D are known to be more likely to develop other autoimmune diseases than the general population.

Currently, the current International Society for Pediatric and Adolescent Diabetes Guidelines recommend screening for Hashimoto’s disease at T1D diagnosis and every 2 years during follow-up, and screening for celiac disease at T1D diagnosis and after 2 years and 5 years of diabetes duration.

Researchers conducted a single-center retrospective cohort study to describe additional autoimmunity in a cohort of children and adolescents with T1D.

The researchers also sought to identify factors associated with the presence of additional autoantibodies and of additional autoimmune diseases.

The cohort included 179 children and adolescents with a mean age of 9.1 years who had been diagnosed with T1D between 2014 and 2020. Patients were identified by admittance into the Regional University Hospital of Nancy (France) for diabetes mellitus onset.

Patients were screened for autoimmune thyroiditis and celiac disease at T1D diagnosis and every 1-2 years through February 2021. The mean follow up was 37 months.

Patients were only screened for other additional autoimmune diseases and their specific autoantibodies if clinical or laboratory signs were present.

The study found that 15.6% of participants present with at least 1 type of additional autoantibodies. Additional autoantibodies specific to Hashimoto’s disease were the most frequent, followed by those for celiac disease.

Only 2.8% of participants presented with additional autoimmune diseases as early as T1D diagnosis.

At 2 years of follow-up, the cumulative incidence of additional autoantibodies was 3.9% and the cumulative incidence of additional autoimmune diseases was 5.4%.

These incidences doubled from 1-2 years of follow-up and from 2-3 years of follow-up. By the third year, both incidences reached approximately 10%.

These findings support previous literature indicating that the prevalence of additional autoimmunity to T1D increases with T1D duration.

Hashimoto’s disease was the most frequently diagnosed additional autoimmune disease, followed by celiac disease. Both were most frequently diagnosed at an asymptomatic stage, suggesting the importance of systematic screening, noted the authors.

Though few patients were affected, Vitiligo and Graves’ disease were also diagnosed in the cohort.

The authors noted that 2 patients with Down syndrome, who are known to have increased susceptibility to autoimmunity, were included in the study. One of these patients was affected by 2 additional autoimmune diseases, while the other was affected by only 1 additional autoimmune disease.

Children aged 6-12 were found to be more likely to present with an additional autoimmune disease at diabetes diagnosis, though the authors note that these results may be biased due to this being the largest age group in the cohort (P = .043).

No other statistical association with age was found for additional autoimmune diseases diagnosed during follow-up, nor for the detection of additional autoantibodies at any time during the study.

Additionally, no association was found between other anthropometric factors, metabolic factors, and the detection of additional autoantibodies or the diagnosis of additional autoimmune diseases at diabetes diagnosis or during follow-up, inconsistent with previous studies.

Generally, the authors assert that the high prevalence and incidence of additional autoimmunity in children and adolescents with T1D justifies regular screening of additional autoantibodies and additional autoimmune diseases.

“In the future, better identification of factors associated with the presence of each specific additional autoimmune diseases could help tailor screening to each patient,” they wrote.

However, noting the limitations of their study, the authors suggest that future studies on larger prospective cohorts with longer follow-ups are needed to better characterize the incidence, the natural history, and the factors associated with additional autoantibodies and additional autoimmune diseases in children and adolescents with T1D.

Reference

Burbaud M, Renard E, Jellimann S, Luc A, Di Patrizio M, Remen T, et al. Additional autoimmune diseases associated with type 1 diabetes in children and adolescents: A French single-center study from 2014 to 2021. Archives de Pédiatrie. 2022; 29(5):381-387. doi:10.1016/j.arcped.2022.03.002