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92
VOLUME 8 NUMBER 2 • JUNE 2011
JOURNAL UPDATE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Journal Update
Clinical audit of autoimmune disorders in type 1 diabetes: South African CDE study
I
n the previous issue of the
South Afri-
can Journal of Diabetes and Vascular Dis-
ease
(volume 8, number 1, March 2011) we
reviewed advances in the field of autoimmune
diseases in diabetes, with a particular focus
on published South African research contribu-
tions. The following important study from the
Centre for Diabetes and Endocrinology (CDE)
in Johannesburg was not included.
This study of 504 patients with long-
standing, established type 1 diabetes com-
prised about 20% of the total type 1 diabetes
patients treated at this centre. Patients were
mainly Caucasian, except for six Asian and
four African patients. Men and women were
equally represented.
The dataset was evaluated for hypothyroid-
ism, adrenocortical insufficiency, pernicious
anaemia, coeliac disease, vitiligo or a systemic
autoimmune disorder. Clinical diagnoses were
confirmed biochemically.
Of particular interest was the high preva-
lence (one in five patients overall; 31% female
and 10%male) of hypothyroidism. Other auto-
immune disorders were much less common,
but consistently occurred more frequently in
female patients (Table 1).
It should be noted that not all the cases of
hypothyroidism should be regarded as autoim-
mune, as thyroid antibodies were not routinely
documented. Nonetheless, this large cross-
sectional audit of clinical practice underscores
the known strong association between type 1
diabetes and hypothyroidism. Hypothyroidism
also occurred together with adrenal insuffi-
ciency (six patients), vitiligo (six patients) and
systemic autoimmunity (five patients).
The next, less-frequent endocrine associa-
tion found was that of adrenocortical insuffi-
ciency. The combination in a single patient with
hypothyroidism supported the diagnosis of
autoimmune polyglandular syndrome type 2.
The authors concluded with the recommen-
dation that screening for thyroid autoimmune
disease should become part of the routine
investigation of newly diagnosed type 1 dia-
betic patients.
J Aalbers, Special Assignments Editor
Table 1.
Distribution of autoimmune features in 504 patients with type 1 diabetes attending the CDE.
Group Number
Hypothyroidism
(%)
Adrenal
insufficiency (%)
Pernicious
anaemia (%)
Coeliac disease
(%)
Vitiligo (%)
Systematic
autoimmune
diseases* (%)
Total
504
20.2
1.8
0.4
0.6
2
1.6
Females
246
30.9
2.4**
0.8
1.2
2.8
2.8
Males
258
10.1
1.2
0
0
1.2
0.4
*Rheumatoid arthritits, scleroderma, systemic lupus erythematosis.
**
p
<
O.0002 compared to males.
Amended from Joffe B, Distiller L, Landau S, Blacking L, Klisiewicz A. Spectrum of autoimmune disorders in type 1 diabetes – A cross-sectional clinical audit.
J Diabetes Metabol
2010;
1
: 112. doi:10.4172/2155-6156.1000112.
Diary for 2011 diabetes congresses
DATE
PLACE
CONFERENCE
WEBSITE
22–24 July
Johannesburg, SA
13th CDE Postgraduate Forum in Diabetes Management (CDE)
www.cdecentre.co.za
1–2 September
Berlin, Germany
4th EPCCS annual scientific meeting for primary care in
cardiovascular disease
www.epccs.eu
12–16 September Lisbon, Portugal
47th EASD meeting
www.easd.org
4–8 December
Dubai International Convention &
Exhibition Centre Dubai, UAE
IDF World Diabetes congress
www.worlddiabetescongress.org
