Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience

Introduction: Diabetes guidelines recommend routine screening for autoimmune thyroid disease (ATD) and celiac disease, especially in cases of childhood-onset type 1 diabetes (T1D). However, the level of evidence is weak (expert opinion), and for adult-onset T1D even less clear. The aim of this study is to evaluate the prevalence of comorbid autoimmune diseases (ADs) in childhood-onset and adult-onset T1D patients, and to compare the distribution of individual ADs with those with type 2 diabetes mellitus (T2D). Methods: Among a total of 1594 adult diabetes patients who were consecutively followed by a single Diabetes Center, 22% (n=351) had T1D. Patients with T1D were screened for ATD, pernicious anemia, vitiligo, celiac, and when clinically relevant for Addison’s, and other organ-specific/systemic autoimmune/autoinflammatory diseases. To compare the distribution of ADs, we included a group of 50 T2D patients with at least one known autoimmunity. In addition, the relationship between ADs, and the level of glycemic control and the presence of micro- and macrovascular complications were investigated. Results: The prevalence of AD was 26.2% in T1D with females being more affected than males. ATD was the most prevalent, followed by pernicious anemia, vitiligo, celiac, and premature gonadal failure. Over 60% had single (mostly ATD; T1D 83.6%, T2D 68.6%), and over 20% had double AD with no significant difference between T1D and T2D. Of T1D patients, 8.2% had triple AD. The majority of ATDs was Hashimoto’s thyroiditis and/or hypothyroidism, only 12% had Graves’ disease (T1D 10.9% and T2D 14%). In T1D women, pernicious anemia (22.8%), vitiligo (9.8%), and celiac (8.7%) were the most common comor- bidities of ATD. There was no significant relationship between the frequency of ADs and individual ADs and glycemic control, age-at-onset of diabetes, and micro- and macrovascular complications. Discussion and Conclusion: Screening for ATD should be included in the routine management protocol of adult-onset T1D as recommended in those with childhood-onset. Furthermore, we suggest investigation for pernicious anemia, vitiligo, and celiac disease in women with T1D.

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1. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169–80.
2. Roizen JD, Bradfield JP, Hakonarson H. Progress in under - standing Type 1 diabetes through its genetic overlap with other autoimmune diseases. Curr Diab Rep 2015;15:102.
3. Barker JM, Yu J, Yu L, Wang J, Miao D, Bao F, et al. Autoanti- body “subspecificity” in Type 1 diabetes: risk for organ-spe- cific autoimmunity clusters in distinct groups. Diabetes Care 2005;28:850–5.
4. Velloso LA, Eizirik DL, Cnop M. Type 2 diabetes mellitus--an autoimmune disease? Nat Rev Endocrinol 2013;9:750–5.
5. Prattichizzo F, De Nigris V, Spiga R, Mancuso E, Sala LL, Antoni- celli R, et al. Inflammageing and metaflammation: the yin and yang of Type 2 diabetes. Ageing Res Rev 2018;41:1–17.
6. Tuomi T, Santoro N, Caprio S, Cai M, Weng J, Groop L. The many faces of diabetes: a disease with increasing heterogene- ity. Lancet 2014;383:1084–94.
7. American Diabetes Association. 3. comprehensive medical evaluation and assessment of comorbidities. Diabetes Care 2017;40:S25–32.
8. American Diabetes Association. 2. Classification and diagno- sis of diabetes: standards of medical care in diabetes-2021. Diabetes Care 2021;44:S15–33.
9. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016;26:1343–421.
10. Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American association of clinical endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002;8:457–69.
11. Makimattila S, Harjutsalo V, Forsblom C, Groop PH, FinnDiane Study Group. Every fifth ındividual with Type 1 diabetes suf- fers from an additional autoimmune disease: A finnish nation- wide study. Diabetes Care 2020;43:1041–7.
12. Bao YK, Weide LG, Ganesan VC, Jakhar I, McGill JB, Sahil S, et al. High prevalence of comorbid autoimmune diseases in adults with Type 1 diabetes from the health facts database. J Dia-betes 2019;11:273–9.
13. Nederstigt C, Uitbeijerse BS, Janssen LG, Corssmit EP, de Kon- ing EJ, Dekkers OM. Associated auto-immune disease in Type 1 diabetes patients: a systematic review and meta-analysis. Eur J Endocrinol 2019;180:135–44.
14. Aygun C, Uraz S, Damci T, Osar Z, Yumuk V, Akdenizli E, et al. Celiac disease in an adult Turkish population with Type 1 dia- betes mellitus. Dig Dis Sci 2005;50:1462–6.
15. Dagdelen S, Hascelik G, Bayraktar M. Simultaneous triple or- gan specific autoantibody profiling in adult patients with Type 1 diabetes mellitus and their first-degree relatives. Int J Clin Pract 2009;63:449-56.
16. Guvenc S, Kaymakoglu S, Gurel N, Karşidağ K, Demir K, Dinçer D, et al. The prevalence of manifest and latent celiac disease in Type 1 diabetes mellitus. Turk J Gastroenterol 2002;13:103–7.
17. Frommer L, Kahaly GJ. Type 1 diabetes and associated autoim- mune diseases. World J Diabetes 2020;11:527–39.
18. Chantzichristos D, Persson A, Miftaraj M, Eliasson B, Svensson AM, Johannsson G. Early clinical indicators of addison disease in adults with Type 1 diabetes: a nationwide, observational, cohort study. J Clin Endocrinol Metab 2019;104:1148–57.
19. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: A position statement by the American diabetes association. Diabetes Care 2017;40:136–54.
20. Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA 2010;304:649–56.
21. Bakker SF, Tushuizen ME, von Blomberg ME, Mulder CJ, Simsek S. Type 1 diabetes and celiac disease in adults: glycemic con- trol and diabetic complications. Acta Diabetol 2013;50:319–24.
22. Hemminki K, Liu X, Forsti A, Sundquist J, Sundquist K, Ji J. Sub- sequent Type 2 diabetes in patients with autoimmune dis- ease. Sci Rep 2015;5:13871.
23. Diez JJ, Iglesias P. An analysis of the relative risk for hy- pothyroidism in patients with Type 2 diabetes. Diabet Med 2012;29:1510–4.

APA	TANRIKULU S, YALIN G, Cakmak R, TEKİN S, HACIŞAHİNOĞULLARI H, TÜTÜNCÜ Y, GÜL N, Soyluk Selcukbiricik O, ÜZÜM A, Karşıdağ K, DİNÇÇAĞ N, YILMAZ M, Satman I (2021). Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. , 346 - 351. 10.14744/hnhj.2019.59852
Chicago	TANRIKULU Seher,YALIN Gülşah Yenidünya,Cakmak Ramazan,TEKİN Sakin,HACIŞAHİNOĞULLARI Hülya,TÜTÜNCÜ Yıldız,GÜL Nurdan,Soyluk Selcukbiricik Ozlem,ÜZÜM Ayşe Kubat,Karşıdağ Kubilay,DİNÇÇAĞ Nevin,YILMAZ Mehmet Temel,Satman Ilhan Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. (2021): 346 - 351. 10.14744/hnhj.2019.59852
MLA	TANRIKULU Seher,YALIN Gülşah Yenidünya,Cakmak Ramazan,TEKİN Sakin,HACIŞAHİNOĞULLARI Hülya,TÜTÜNCÜ Yıldız,GÜL Nurdan,Soyluk Selcukbiricik Ozlem,ÜZÜM Ayşe Kubat,Karşıdağ Kubilay,DİNÇÇAĞ Nevin,YILMAZ Mehmet Temel,Satman Ilhan Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. , 2021, ss.346 - 351. 10.14744/hnhj.2019.59852
AMA	TANRIKULU S,YALIN G,Cakmak R,TEKİN S,HACIŞAHİNOĞULLARI H,TÜTÜNCÜ Y,GÜL N,Soyluk Selcukbiricik O,ÜZÜM A,Karşıdağ K,DİNÇÇAĞ N,YILMAZ M,Satman I Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. . 2021; 346 - 351. 10.14744/hnhj.2019.59852
Vancouver	TANRIKULU S,YALIN G,Cakmak R,TEKİN S,HACIŞAHİNOĞULLARI H,TÜTÜNCÜ Y,GÜL N,Soyluk Selcukbiricik O,ÜZÜM A,Karşıdağ K,DİNÇÇAĞ N,YILMAZ M,Satman I Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. . 2021; 346 - 351. 10.14744/hnhj.2019.59852
IEEE	TANRIKULU S,YALIN G,Cakmak R,TEKİN S,HACIŞAHİNOĞULLARI H,TÜTÜNCÜ Y,GÜL N,Soyluk Selcukbiricik O,ÜZÜM A,Karşıdağ K,DİNÇÇAĞ N,YILMAZ M,Satman I "Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience." , ss.346 - 351, 2021. 10.14744/hnhj.2019.59852
ISNAD	TANRIKULU, Seher vd. "Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience". (2021), 346-351. https://doi.org/10.14744/hnhj.2019.59852

APA	TANRIKULU S, YALIN G, Cakmak R, TEKİN S, HACIŞAHİNOĞULLARI H, TÜTÜNCÜ Y, GÜL N, Soyluk Selcukbiricik O, ÜZÜM A, Karşıdağ K, DİNÇÇAĞ N, YILMAZ M, Satman I (2021). Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. Haydarpaşa Numune Medical Journal, 61(3), 346 - 351. 10.14744/hnhj.2019.59852
Chicago	TANRIKULU Seher,YALIN Gülşah Yenidünya,Cakmak Ramazan,TEKİN Sakin,HACIŞAHİNOĞULLARI Hülya,TÜTÜNCÜ Yıldız,GÜL Nurdan,Soyluk Selcukbiricik Ozlem,ÜZÜM Ayşe Kubat,Karşıdağ Kubilay,DİNÇÇAĞ Nevin,YILMAZ Mehmet Temel,Satman Ilhan Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. Haydarpaşa Numune Medical Journal 61, no.3 (2021): 346 - 351. 10.14744/hnhj.2019.59852
MLA	TANRIKULU Seher,YALIN Gülşah Yenidünya,Cakmak Ramazan,TEKİN Sakin,HACIŞAHİNOĞULLARI Hülya,TÜTÜNCÜ Yıldız,GÜL Nurdan,Soyluk Selcukbiricik Ozlem,ÜZÜM Ayşe Kubat,Karşıdağ Kubilay,DİNÇÇAĞ Nevin,YILMAZ Mehmet Temel,Satman Ilhan Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. Haydarpaşa Numune Medical Journal, vol.61, no.3, 2021, ss.346 - 351. 10.14744/hnhj.2019.59852
AMA	TANRIKULU S,YALIN G,Cakmak R,TEKİN S,HACIŞAHİNOĞULLARI H,TÜTÜNCÜ Y,GÜL N,Soyluk Selcukbiricik O,ÜZÜM A,Karşıdağ K,DİNÇÇAĞ N,YILMAZ M,Satman I Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. Haydarpaşa Numune Medical Journal. 2021; 61(3): 346 - 351. 10.14744/hnhj.2019.59852
Vancouver	TANRIKULU S,YALIN G,Cakmak R,TEKİN S,HACIŞAHİNOĞULLARI H,TÜTÜNCÜ Y,GÜL N,Soyluk Selcukbiricik O,ÜZÜM A,Karşıdağ K,DİNÇÇAĞ N,YILMAZ M,Satman I Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience. Haydarpaşa Numune Medical Journal. 2021; 61(3): 346 - 351. 10.14744/hnhj.2019.59852
IEEE	TANRIKULU S,YALIN G,Cakmak R,TEKİN S,HACIŞAHİNOĞULLARI H,TÜTÜNCÜ Y,GÜL N,Soyluk Selcukbiricik O,ÜZÜM A,Karşıdağ K,DİNÇÇAĞ N,YILMAZ M,Satman I "Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience." Haydarpaşa Numune Medical Journal, 61, ss.346 - 351, 2021. 10.14744/hnhj.2019.59852
ISNAD	TANRIKULU, Seher vd. "Autoimmune Diseases in Turkish Patients with Type 1 and Type 2 Diabetes: A Single-center Experience". Haydarpaşa Numune Medical Journal 61/3 (2021), 346-351. https://doi.org/10.14744/hnhj.2019.59852