Higher Relative Risk for Multiple Sclerosis in a Pediatric and Adolescent Diabetic Population: Analysis From DPV Database

Abstract

OBJECTIVEType 1 diabetes and multiple sclerosis (MS) are typical autoimmune diseases in children and young adults. We assessed the co-occurrence of type 1 diabetes and MS by estimating the relative risk (RR) for MS in a pediatric and adolescent diabetic population and looked for possible influencing factors. RESEARCH DESIGN AND METHODSWithin the Diabetes Patienten Verlaufsdokumentation (DPV)-Wiss Project, from January 1995 to October 2012, data from 56,653 patients with type 1 diabetes were collected in 248 centers in Germany and Austria. Published data on German and Mid-European MS prevalence were taken for comparison. Multivariable regression analysis was used to identify confounders for co-occurrence of type 1 diabetes and MS. RESULTSThe RR for MS in patients with type 1 diabetes was estimated at 3.35-4.79 (95% CI 1.56-7.21 and 2.01-11.39, respectively). Immigration status in all patients (P < 0.05) and the presence of thyroid antibodies in male patients only (P = 0.05) were identified as influencing factors on MS incidence within the DPV database. The month-of-birth pattern revealed that risk was higher during the spring and summer months in the population with type 1 diabetes and MS in comparison with the population with type 1 diabetes. CONCLUSIONSThe present cohort study demonstrates a higher risk of co-occurrence of MS in a pediatric and adolescent diabetic population. Immigration status and thyroid antibodies in male patients were independent risk indicators for the incidental rate of MS. Diabetic patients born during spring and summer had a higher risk for the development of MS. We suggest that environmental factors modulate the individual's risk for the co-occurrence of both diseases.

The co-occurrence of multiple sclerosis and type 1 diabetes: Shared aetiologic features and clinical implication for MS aetiology

“…Bechtold and colleagues [10] investigated the co-occurrence of T1D and MS by estimating the relative risk for MS in a paediatric and adolescent diabetes population. Data on 56,653 patients with T1D in the Diabetes Patienten Verlaufsdokumentation (DPV) database were collected in 248 centres in Germany and Austria and published data on German and Mid-European MS prevalence were used for comparison.…”

“…While MS is predominantly associated with neurological and physical disabilities and loss of function resulting from inflammatory demyelination and neurodegeneration of the central nervous system (CNS) [7], the chronic hyperglycaemic condition characteristic of T1D results from the selective inflammatory autoimmune destruction of the pancreatic Islets of Langerhans responsible for insulin production [8]. Despite the organ specificity of these two disorders, a possible aetiologic and pathologic relationship between the two diseases has been suggested [9,10]. The framework behind the co-occurrence is unclear.…”

ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes

“…Other autoimmune conditions more commonly diagnosed in patients with type 1 diabetes include primary adrenal insufficiency, collagen vascular disease (eg, rheumatoid arthritis, lupus, psoriasis, scleroderma), other gastrointestinal diseases (eg, Crohn's disease, ulcerative colitis, autoimmune hepatitis, autoimmune gastritis), and skin disease (eg, vitiligo, scleroderma). Rarer autoimmune conditions, such as multiple sclerosis, which have also been associated with type 1 diabetes in childhood and adolescence, will not be described in detail …”

Clinical Characteristics and Outcome of 467 Patients With a Clinically Recognized Eating Disorder Identified Among 52,215 Patients With Type 1 Diabetes: A Multicenter German/Austrian Study

“…Patient demographics, type and onset of diabetes, metabolic control, treatment regimen, and comorbidities are entered into the electronic health record. Twice a year, participating centers transmit their locally documented data anonymously to Ulm, Germany, for central analyses (10,11) and quality assurance. In case of inconsistent data, participating centers are requested to correct data entries.…”