A recent study from the Washington University School of Medicine in St. Louis published in the Journal of Clinical Endocrinology and Metabolism showed that among children with type 1 diabetes “autoimmune diseases begin early in childhood, where nearly 20% of those under age 6 already have an additional disease other than type 1.”
The study, which included 26,000 participants in a type 1 clinical registry, found that contrary to prior assumptions immune diseases did not peak at a certain time of life. Instead, results showed that as people with type 1 diabetes age, they are more likely to develop other autoimmune diseases, with “nearly 50% of those over age 65 accumulating one or more additional autoimmune disease.”
Among people with type 1 diabetes, certain autoimmune conditions were more prevalent, including thyroid disease (occurring in 24% or 6,097 participants); gastrointestinal disorders such as celiac disease (occurring in 6% or 1,530 participants) and other collagen vascular disorders that affect connective tissues, such as lupus, rheumatoid arthritis, and scleroderma.
Older Caucasian women exhibited an increased likelihood of contracting additional autoimmune diseases above any other group.
“An autoimmune condition is one in which certain cells in the immune system become confused and mistake normal body tissues for foreign substances,” says Alicia M. Diaz Thomas, MD, a pediatric endocrinologist and spokesperson for the Endocrine Society. “The cells act up on—or attack—normal body tissues and prevent them from working correctly.”
The ability of immune cells to recognize “self” and not attack normal body tissues is called “immune tolerance” and typically, the immune system needs to be correctly programmed to not attack normal tissues.
“Hereditary or environmental causes have been thought to trigger an abnormal response in the immune system and problems with recognizing self vs. other,” says Dr. Diaz Thomas. “Thus a faulty immune system–one that already has one autoimmune condition—may have more of a propensity to attack normal tissues than one that is correctly programmed.”
But while autoimmune diseases can run in groups, Dr. Diaz Thomas notes that while “sometimes it’s related to a particular genetic susceptibility, while other times it may not be so clear.”
Patients with type 1 diabetes should let their endocrinologists know how they are feeling if there is any change in energy, unintended weight loss, stomach symptoms, temperature intolerance or skin or hair changes, says Dr. Diaz Thomas.
“They should also note if they are having changes in blood sugar patterns that are unexplained or in particular, a reduction in the amount of insulin they usually need that is not related to physical activity,” she says.
The most common conditions that strike people with type 1 diabetes include:
“Keeping your blood sugar in as best control as possible will improve the management of the other conditions,” says Dr. Diaz Thomas. “And making sure that you have clear communication with your endocrinologist will be important to identify and manage these problems.”
Effects on Type 2?
People with type 1 diabetes have a higher risk for autoimmune conditions than people with type 2, in part because of the underlying cause of the condition itself.
“Since type 2 diabetes is not a classical autoimmune condition, there is less risk for other autoimmune complications,” says Dr. Diaz Thomas. “There is not a dysregulated immune system that is affecting beta cells and causing them not to produce insulin. On the contrary, people with type 2 diabetes are known to continue to produce insulin, but its function in the body is reduced.”
However, she notes that type 2 can be considered an inflammatory condition, and as such “there may be other components of the immune system that are involved in type 2 diabetes.”