CELIAC AND AUTOIMMUNE THYROID DISEASE IN PATIENTS WITH ANTI-GAD POSITIVE TYPE-1 DIABETES MELLITUS
Keywords:Anti-GAD antibodies, Anti-thyroid antibodies, Celiac disease, HbA1c, Type-1 diabetes mellitus
AbstractBackground: Type-1 diabetes mellitus (T1DM) and autoimmune thyroid disease can occur concomitantly and patients with TIDM have a high risk of other autoimmune conditions like thyroid disease and celiac disease. This study aimed to analyze the association of anti-GAD positive T1DM with anti-thyroid antibodies and celiac disease. Methods: This cross-sectional study was conducted at the Department of Paediatric Endocrinology & Diabetes, National Institute of Child Health, Karachi Pakistan from July 2022 to December 2022. A total of 115 children of both genders aged between 1–18 years having known T1DM were analyzed. Children with chronic kidney disease or chronic liver disease were excluded. Those children were also not included whose parents/caregivers did not wish their children to be part of this research. The blood sample of each child was taken in a sterilized container and sent to an institutional laboratory for biochemical investigations. Results: In a total of 115 patients, 67 (58.3%) were female and 48 (41.7%) males. The mean age was 8.87±3.43 (ranging between 1.5–17 years). The mean HbA1c was 11.86±7.31%. It was found that anti-GAD IgG was having signification association with celiac disease (p<0.001). Significant correlation of anti-GAD positive antibodies with Ttg-IgG antibodies (correlation coefficient=0.303, p=0.001), thyroid peroxidase antibodies (correlation coefficient=0.228, p=0.001). Conclusion: High proportions of children with anti-GAD positive T1DM patients were found to have thyroid disorders and celiac disease. A significant correlation was found between anti-GAD positive antibodies, celiac disease and anti-thyroglobulin antibodies.
Orzan A, Novac C, Mihaiela MI, Tirgoviste CI, Balgradean M. Type 1 diabetes and thyroid autoimmunity in children. Maedica 2016;11(4):308.
Gul K, Ustun I, Aydin Y, Berker D, Erol HK, Unal M, et al. Autoimmune thyroid disease in patients with anti-GAD positive type 1 diabetes mellitus. Cent Eur J Med 2009;4(4):415–22.
Kakleas K, Paschali E, Kefalas N, Fotinou A, Kanariou M, Karayianni C, et al. Factors for thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Ups J Med Sci 2009;114(4):214–20.
Li L, Liu S, Yu J. Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective? Ther Adv Endocrinol Metab 2020;11:2042018820958329.
Kawasaki E. Type 1 diabetes and autoimmunity. Clin Pediatr Endocrinol 2014;23(4):99–105.
Karuranga S, Fernandes JDR, Huang Y, Malanda B. IDF Diabetes Atlas. 8th ed. International Diabetes Federation; 2018.
Oyenusi EE, Ajayi EO, Akeredolu FD, Oduwole AO. Pattern of thyroid disorders in children and adolescents seen at the Lagos university teaching hospital, Nigeria, over a 10-year period. Niger Med J 2017;58(3):101–6.
Leung AKC, Leung AAC. Evaluation and management of the child with hypothyroidism. World J Pediatr 2019;15(2):124–34.
Krzewska A, Ben-Skowronek I. Effect of associated autoimmune diseases on type 1 diabetes mellitus incidence and metabolic control in children and adolescents. BioMed Res Int 2016;2016:6219730.
Fatourechi A, Ardakani HM, Sayarifard F, Sheikh M. Hypothyroidism among pediatric patients with type 1 diabetes mellitus, from patients' characteristics to disease severity. Clin Pediatr Endocrinol 2017;26(2):73–80.
Léger J, Carel JC. Hyperthyroidism in childhood: causes, when and how to treat. J Clin Res Pediatr Endocrinol 2013;5(Suppl 1):50–6.
Bhadada SK, Kochhar R, Bhansali A, Dutta U, Kumar PR, Poornachandra KS, et al. Prevalence and clinical profile of celiac disease in type 1 diabetes mellitus in north India. J Gastroenterol Hepatol 2011;26(2):378–81.
Agrawal RP, Rathore A, Joshi A, Changal H, Kochar DK. Prevalence of celiac disease in type 1 diabetes mellitus in North West Rajasthan, India. Diabetes Res Clin Pract 2008;79(1):e15–6.
Walker-Smith JA, Grigor W. Cœliac disease in a diabetic child. Lancet 1969;293(7603):1021.
Pulikkal AA, Kolly A, Kumar KP, Shivaprasad C. The seroprevalence of immunoglobulin A transglutaminase in type 1 diabetic patients of South Indian origin. Ind J Endocrinol Metabol 2016;20(2):233–7.
Sharma B, Nehara HR, Saran S, Bhavi VK, Singh AK, Mathur SK. Coexistence of autoimmune disorders and type 1 diabetes mellitus in children: an observation from western part of India. Indian J Endocrinol Metab 2019;23(1):22–6.
Marwaha RK, Garg MK, Tandon N, Kanwar R, Narang A, Sastry A, et al. Glutamic acid decarboxylase (anti-GAD) & tissue transglutaminase (anti-TTG) antibodies in patients with thyroid autoimmunity. Indian J Med Res 2013;137(1):82.
Basu M, Pandit K, Banerjee M, Mondal SA, Mukhopadhyay P, Ghosh S. Profile of auto-antibodies (Disease related and other) in children with type 1 diabetes. Indian J Endocrinol Metab 2020;24(3):256–9.
Riseh SH, Farhang MA, Mobasseri M, Jafarabadi MA. The Relationship between Thyroid Hormones, Antithyroid Antibodies, Anti-Tissue Transglutaminase and Anti-Gliadin Antibodies in Patients with Hashimoto's Thyroiditis. Acta Endocrinol (Buchar) 2017;13(2):174–9.
Oujamaa I, Sebbani M, Elmoumou L, Bourrahouate A, El Qadiry R, El Moussaoui S, et al. The Prevalence of Celiac Disease-Specific Auto-Antibodies in Type 1 Diabetes in a Moroccan Population. Int J Endocrinol 2019;2019:7895207.
Umpierrez GE, Latif KA, Murphy MB, Lambeth HC, Stentz F, Bush A, et al. Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. Diabetes Care 2003;26(4):1181–5.
Hansen D, Bennedbaek FN, Høier-Madsen M, Hegedüs L, Jacobsen BB. A prospective study of thyroid function, morphology and autoimmunity in young patients with type 1 diabetes. Eur J Endocrinol 2003;148(2):245–51.
Holl RW, Bohm B, Loos U, Grabert M, Heinze E, Homoki J. Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Effect of age, gender and HLA type. Horm Res 1999;52(3):113–8.
Copyright (c) 2023 Versha Rani Rai, Zubair Khoso, Maira Riaz, Roshia Parveen, Shazia Mahar, Mohsina Noor
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.