High prevalence of systemic rheumatic diseases in women with type 1 diabetes

https://doi.org/10.1016/j.jdiacomp.2018.06.001Get rights and content

Abstract

Background

The prevalence of systemic rheumatic diseases (SRDs) in T1DM has not been described.

Method

This observational study compares SRD prevalence across age, race, and gender in 1,212 adults with T1DM.

Findings

There is an age-dependent enrichment of SRDs in women with T1DM: 9.2% prevalence in women overall and 14% in women over age 50.

Conclusion

Clinicians taking care of older women with T1DM should monitor for these SRDs.

Introduction

Type 1 diabetes mellitus (T1DM) is frequently associated with other endocrine and non-endocrine autoimmune diseases due to shared genetic predispositions.1., 2., 3. However, we have limited insight into the epidemiology of autoimmune diseases in older adults with T1DM. Data on the prevalence of systemic rheumatic diseases (SRDs) in persons with T1DM is particularly scarce.

Systemic rheumatic diseases, including rheumatoid arthritis, scleroderma, and systemic vasculitides, are debilitating conditions that disproportionately affect women. Having an SRD in addition to T1DM may further complicate care of both conditions, and may worsen cardiovascular and metabolic bone disease risks.4 Several studies have suggested a genetic link between SRDs and T1DM.5., 6., 7. We now aim to better characterize the prevalence, risk factors, and ages of onset of SRDs in a cohort of patients with T1DM.

Section snippets

Methods

This observational, cross-sectional study was approved by the Washington University Human Research Protection Office. Patients with T1DM seen at the Washington University Diabetes Center from 2011 to 2018 completed a questionnaire including date of birth, gender, race, age of T1DM onset, concurrent SRD diagnoses, and age of onset of each SRD. Patient charts were reviewed for verification.

Study population

Participants included 1212 individuals with T1DM, mean age 46.8 ± 16.2 years, range 19–96. Participants were 51.8% female; 89.6% white, 9.0% black, and 1.4% other race/ethnicity. Median T1DM onset age was 18.0 years, mean 21.2 ± 14.4 years. 6.5% of the cohort had a SRD, and of these, 63.3% had one or more non-SRD autoimmune diseases, such as hypothyroidism, hyperthyroidism, pernicious anemia, and celiac disease. Having T1DM plus SRD significantly raised the risk of additional autoimmune

Discussion

This study has three main findings: 1) SRD prevalence is high among persons with T1DM, 2) women with T1DM are at higher risk than men, and 3) individuals with T1DM and SRD are more likely to have additional AID than those without an SRD. Prior studies of AID prevalence in T1DM cohorts have reported low prevalence of SRD, generally under 2% (single or overall SRD).8,9 However, the mean age of these cohorts is <20 years. In contrast, our cohort with a mean age of 46 years demonstrated

Acknowledgements

This work was supported by the Washington University Diabetes Research Center (DRC) through NIH grant P30 DK020579 (to J.B.M.), the Doris Duke Charitable Foundation grant #2015215 (to J.W.H.) and NIH training grant T32DK007120 (to Y.B., J.W.H.). We thank Mary Jane Clifton, Carol Recklein, and Garrett Pagano for administrative and data collection support. We thank Dr. Philip Miller, Professor of Biostatistics at Washington University School of Medicine, for helpful discussions of data analysis.

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