. 2024 Jan 22.
doi: 10.1007/s00125-024-06086-8.Online ahead of print.

Autoimmune comorbidity in type 1 diabetes and its association with metabolic control and mortality risk in young people: a population-based study



This register-based study aimed to describe autoimmune comorbidity in children and young adults from type 1 diabetes onset, and to investigate whether such comorbidity was associated with a difference in HbA1cor mortality risk compared with children/young adults with type 1 diabetes without autoimmune comorbidity.

A total of 15,188 individuals from the Swedish National Diabetes Register, registered with type 1 diabetes before 18 years of age between 2000 and 2019, were included.

Five randomly selected control individuals from the Swedish population (Statistics Sweden) were matched to each individual with type 1 diabetes (n=74,210 [346 individuals with type 1 diabetes were not found in the Statistics Sweden register at the date of type 1 diabetes diagnosis, so could not be matched to control individuals]).

The National Patient Register was used to attain ICD-10 codes on autoimmune diseases and the Cause of Death Register was used to identify deceased individuals.

In the total type 1 diabetes cohort, mean±SD age at onset of type 1 diabetes was 9.5±4.4 years and mean disease duration at end of follow-up was 8.8±5.7 years.

Of the individuals with type 1 diabetes, 19.2% were diagnosed with at least one autoimmune disease vs 4.0% of the control group.

The HRs for comorbidities within 19 years from onset of type 1 diabetes 
• were 11.6 (95% CI 10.6, 12.6) for coeliac disease, 10.6 (95% CI 9.6, 11.8)
• for thyroid disease, 1.3 (95% CI 1.1, 1.6)
• for psoriasis, 4.1 (95% CI 3.2, 5.3)
• for vitiligo, 1.7 (95% CI 1.4, 2.2)
• for rheumatic joint disease, 1.0 (95% CI 0.8, 1.3)
• for inflammatory bowel disease, 1.0 (95% CI 0.7, 1.2)
• for systemic connective tissue disorder, 1.4 (95% CI 1.1, 1.9)
• for uveitis, 18.3 (95% CI 8.4, 40.0)
• for Addison's disease, 1.8 (95% CI 0.9, 3.6)
• for multiple sclerosis, 3.7 (95% CI 1.6, 8.7)
• for inflammatory liver disease and 19.6 (95% CI 4.2, 92.3) for atrophic gastritis.

Autoimmune disease in addition to type 1 diabetes had no statistically significant effect on HbA1cor mortality risk.

To our knowledge, this is the first comprehensive study where young individuals with type 1 diabetes were followed regarding development of a wide spectrum of autoimmune diseases, from onset of type 1 diabetes.

In this nationwide and population-based study, there was already a high prevalence of autoimmune diseases in childhood, especially coeliac and thyroid disease.

The presence of autoimmune comorbidity did not have a statistically significant effect on metabolic control or mortality risk.

Keywords:Adolescents; Autoimmune comorbidity; Children; HbA1c; Metabolic control; Mortality; Quality register; Type 1
diabetes; Young adults.


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