Effect of Associated Autoimmune Diseases on Type 1 Diabetes Mellitus Incidence and Metabolic Control in Children and Adolescents

Table 3

Impact of T1DM-associated autoimmune diseases on the course of T1DM and suggestion concerning screening tests.

T1DM-associated autoimmune diseases	Influence on the glucose metabolism	Impact on the course of T1DM	Suggestion of screening tests
Hashimoto thyroiditis hypothyroidism	↓intestinal glucose absorption; ↓glycogenolysis; ↓insulin catabolism; ↑insulin sensitivity	Hypoglycemia	TSH, fT4, TPO Ab, and Tg Ab every year
Graves’ disease hyperthyroidism	↓intestinal glucose absorption; ↑insulin sensitivity and insulin metabolism in target tissue; lipolysis	Hypoglycemia; Ketoacidosis	TSH, fT4, fT3, and TSI by signs and symptoms thyrotoxicosis or by unexplained hypoglycemias
Celiac disease	↓intestinal glucose absorption	Hypoglycemia	Anti-transglutaminase antibodies TTG or IgA EMA over the years of the disease followed by biennial tests; Gastroscopy with histopathological investigations of the intestinal mucosa by positive tests
Autoimmune gastritis	Pernicious anemia	—	—
Addison disease	↑insulin sensitivity; ↓glycogenolysis; ↓gluconeogenesis; ↑glycolysis	Hypoglycemia	ACTH and cortisol levels by unexplained hypoglycemias or every 2-3 years
JIA, psoriasis, Sjogren syndrome, and other autoimmune diseases during corticosteroid therapy	↓insulin sensitivity; ↑glycogenolysis; ↑gluconeogenesis; ↓glycolysis	Hyperglycemia	—