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- November 19, 2008 |
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"Autoimmune Diseases: Impact on Diabetes"Dr. Trisha O'Moore-Sullivan (biography)
English - 2007-11-21 - 36 minutes
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Summary :
Autoimmune diseases are found more commonly in people with Type 1 Diabetes (T1DM) than amongst the general population. Dr. O'Moore-Sullivan discusses the implications of a diagnosis of autoimmune disease accompanying T1DM, which relate to the management of both conditions, as well as to the screening for other autoimmune diseases in the patient and his family.
A common association with T1DM is Autoimmune Thyroid Disease (AIT), especially hypothyroidism. The presence of thyroid antibodies in patients is associated with a significant increase in TSH. As well as the direct effects of thyroid disease in patients, Dr. O'Moore-Sullivan addresses the additional considerations imposed by T1DM on the management of the autoimmune disease. For example, thyrotoxicosis can lead to poor glycemic control and diabetic ketoacidosis. THS should be measured and monitored in T1DM patients, and this screening process should be offered to the patient's relatives.
Addison's disease (AD), though much rarer than AIT, is more common in patients with T1DM than in the general population and is associated with life-threatening complications. Thus, clinicians must maintain a high index of suspicion when patients report recurrent hypoglycemia or a fall in insulin requirements. Symptoms may present after commencement of treatment with thyroxine. Screening for AD in T1DM remains controversial due to its lower prevalence.
Coeliac disease, in which an autoimmune process is induced by gluten in genetically susceptible individuals, is more common than its variable clinical presentation previously led clinicians to believe. Symptoms, which may often be absent, range from gastrointestinal disturbances to atypical manifestations such as growth delay and transaminitis. Diagnosis is based upon presence of symptoms, serology, and small bowel biopsy. Screening for coeliac disease is recommended amongst T1DM due to the high risk they present and, if necessary, a gluten-free diet should be made part of the diabetes management plan as it decreases the risk of hypoglycemia.
There are world-recognized clusters of autoimmune diseases that are known as Autoimmune Polyendocrine Syndromes (APS). These are rare, but should be considered when a second autoimmune disease is detected in a T1DM patient.
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Learning objectives :
After viewing this presentation the participant will be able to discuss:
-The association of Type 1 Diabetes with the following endocrine autoimmune diseases:
Autoimmune thyroid disease (AIT)
Autoimmune Addison's Disease (AD)
-The association of Type 1 Diabetes with a non-endocrine autoimmune disease, Coeliac Disease (CD)
-Autoimmune Polyendocrine Syndromes (APS)
Bibliographic references :
Jennifer M. Barker Type 1 Diabetes-Associated Autoimmunity: Natural History, Genetic Associations, and ScreeningThe Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 4 1210-1217
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