Ebisuno Tomoko, Tachibana Megumi, Imagawa Akihisa, Kanatsuna Norio, Terasaki Jungo, Abiru Norio, Awata Takuya, Ikegami Hiroshi, Oikawa Yoichi, Osawa Haruhiko, Katsuki Takeshi, Kawasaki Eiji, Kozawa Junji, Kobayashi Tetsuro, Shimada Akira, Takahashi Kazuma, Chujo Daisuke, Tsuchiya Kyoichiro, Nagasawa Kan, Fukui Tomoyasu, Yasuda Kazuki, Yasuda Hisafumi, Kajio Hiroshi, Hanafusa Toshiaki
Department of Internal Medicine (I), Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, 569-8686 Japan.
Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
Diabetol Int. 2024 Oct 9;16(1):39-49. doi: 10.1007/s13340-024-00764-z. eCollection 2025 Jan.
Type 1 diabetes is often accompanied by autoimmune thyroid disease. We aimed to investigate the clinical characteristics of Japanese patients with acute-onset type 1 diabetes and thyroid autoantibodies, focusing on decreased endogenous insulin secretion.
We examined 80 patients with acute-onset type 1 diabetes, classifying them into two groups with and without thyroid autoantibodies and compared the clinical characteristics of the two groups. A fasting serum C-peptide immunoreactivity (CPR) of less than 0.1 ng/mL was defined as insulin depletion.
In patients with thyroid autoantibodies, the median fasting serum CPR levels at the fourth year after the onset of type 1 diabetes were significantly lower than in those without thyroid autoantibodies (= 0.02). The cumulative incidence of insulin depletion at 5 years of duration after diagnosis of type 1 diabetes was significantly higher in thyroid autoantibody-positive group than in thyroid autoantibody-negative group ( = 0.01). In the Cox proportional models adjusted for selected baseline factors (age, sex, and BMI), the presence of thyroid autoantibodies did not increase the risk of insulin depletion within 5 years after the onset. However, in bivariate Cox proportional hazards models that investigated the association between thyroid autoantibodies and each baseline factor, the presence of thyroid autoantibodies significantly increased the risk of insulin depletion.
Our study showed that Japanese patients with acute-onset type 1 diabetes and positive for thyroid autoantibodies had a higher risk of insulin deficiency within 5 years after the onset than those without thyroid autoantibodies.
1型糖尿病常伴有自身免疫性甲状腺疾病。我们旨在研究日本急性起病的1型糖尿病患者及甲状腺自身抗体的临床特征，重点关注内源性胰岛素分泌减少的情况。
我们检查了80例急性起病的1型糖尿病患者，将他们分为有甲状腺自身抗体和无甲状腺自身抗体两组，并比较两组的临床特征。空腹血清C肽免疫反应性（CPR）低于0.1 ng/mL被定义为胰岛素耗竭。
在有甲状腺自身抗体的患者中，1型糖尿病发病后第4年的空腹血清CPR水平中位数显著低于无甲状腺自身抗体的患者（P = 0.02）。1型糖尿病诊断后5年时胰岛素耗竭的累积发生率在甲状腺自身抗体阳性组显著高于甲状腺自身抗体阴性组（P = 0.01）。在针对选定基线因素（年龄、性别和BMI）进行调整的Cox比例模型中，甲状腺自身抗体的存在并未增加发病后5年内胰岛素耗竭的风险。然而，在研究甲状腺自身抗体与各基线因素之间关联的双变量Cox比例风险模型中，甲状腺自身抗体的存在显著增加了胰岛素耗竭的风险。
我们的研究表明，日本急性起病且甲状腺自身抗体阳性的1型糖尿病患者在发病后5年内胰岛素缺乏的风险高于无甲状腺自身抗体的患者。
