Thryroid antibodies in patients with type-1 diabetes: Analysis based on the multicenter DPV-database with 19333 patients from 196 centers from Germany and Austria

R. Holl; W. Rabl; S. Hofer; A. Zimmermann; K. Raile; W. S. Liu; O. Kordonouri; W. Marg

doi:10.1055/s-2007-972433

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Thryroid antibodies in patients with type-1 diabetes: Analysis based on the multicenter DPV-database with 19333 patients from 196 centers from Germany and Austria

R Holl ¹, W Rabl ², S Hofer ³, A Zimmermann ⁴, K Raile ⁵, WS Liu ⁶, O Kordonouri ⁷ W Marg ⁸, DPV-Wiss-Studiengruppe

¹Universität Ulm, Institut für Epidemiologie, Ulm, Germany
²Universitätskinderklinik Schwabing, München, Germany
³Universitätskinderklinik, Innsbruck, Austria
⁴Diabetologische Schwerpunktpraxis, Bad Aibling, Germany
⁵Universitätskinderklinik, Berlin, Germany
⁶Universitätskinderklinik, Essen, Germany
⁷Kinderklinik, Hannover, Germany
⁸Kinderklinik, Bremen, Germany

Abstract

Objectives: Autoimmune thyroiditis (Hashimoto) is more prevalent in patients with type-1 diabetes. However, few data address the impact on the longterm course of diabetes.

Methods: DPV is a computer software for standardized longitudinal documentation of patients with diabetes. Twice yearly, anonymized data are transmitted by participating centers for central analysis, including quality control (benchmarking) and epidemiologic analyses. By Oct. 2006, among a total of 42192 patients with type-1 diabetes, at least one measurement of thyroid antibodies was available for 19333 patients with T1DM (mean age 14±5.3 years, mean age at onset: 8.3±4.7 years, 52% male).

Results: In 3592 patients (18.6%), thyroid autoimmunity was present: TPO antibodies were present in 14.3% and TAK antibodies in 10.9% of all patients. 1266 patients (6.6%) were positive for both TAK and TPO antibodies, while 1492 patients (7.7%) were positive for TPO only and 834 (4.3%) for TAK only. Thyroid-AB-positive patients were significantly older (15.5 versus 13.7 years, p<0.0001, Wilcoxon, Holm-adjustment), with a slightly older age at onset of diabetes (8.7 versus 8.2 years, p<0.0001). 63.6% of thyroid-AB-positive patients were female compared to 44.7% of AB-negative patients (p<0.0001). Thyroid-AB-positive patients were more likely to be also positive for B-cell-antibodies (84.5 versus 81.8%, p<0.02) and for gliadin antibodies (18.9 versus 15.2%, p<0.0001). Daily insulin requirement per kg of body weight is lower in thyroid-antibody positive patients after 6 to 10 years of diabetes duration, while no such difference was present for metabolic control as reflected by HbA1c and frequency of severe hypoglycaemia.

Conclusion: Thyroid antibodies are frequent in patients with type-1 diabetes, especially in females. Screening for both TAK and TPO is recommended. Thyroid autoimmunity is associated with B-cell-antibodies and with potential celiac disease. Metabolic results during the first 10 years of diabetes did not differ between thyroid-AB-positive and –negative patients.