The Positivity of Anti-TPO and Anti-tTGA in Children with Type 1 Diabetes Mellitus in Albania

Background: Type 1 diabetes mellitus (T1 DM) is the most common type of diabetes in children. T1DM patients are also at higher risk of other comorbid autoimmune diseases, including autoimmune thyroid disease (AITD), celiac disease (CD). The thyroid-specific immune damage of AITD is strongly associated with elevated serum thyroid peroxidase (TPO). Tissue transglutaminase antibody (tTGA) is a specific antibody and a serological marker of CD. This study aimed to evaluate the positivity of anti - TPO and anti - tTGA in children with T1DM after they were diagnosed. Materials and Methods: This study was conducted from January 2019 to October 2020, included 105 children with T1DM. 44 children matching in aged (1 - 14 years) and gender were taken as control with other diagnoses (16 with viral infection, 24 with short stature, 4 with genetic disorders). The antibodies were checked up for the first time after they were diagnosed. Anti - TPO and anti - tTGA were carried out by ELISA. Results: 55.2% of T1DM children were girls. The anti-TPO was positive in 30.5% of T1DM children compared to 4.5% of children in control group. The anti-tTGA was positive in 7.6% of T1DM children compared to 2.3% of children in control group. Risk of Hashimoto's hypothyroidism was more in children older than 10 years old. 21.9% of children 11 - 14 years old were anti - TPO positive, but it was 16.2%, more common in girls. While, anti - tTGA was positive in 3.85% of children 1 - 5 years old with no difference between boys and girls. Conclusion The most frequent autoimmune disease resulted Hashimoto's hypothyroidism. Girls with T1DM have a higher predisposition to Hashimoto's Hypothyroidism in the 11-14 age group compared to boys. Children with T1DM were found to have a lower predisposition to CD. Children with T1DM have a higher predisposition to develop CD at the age of 1 - 5 years. In conclusion we can say that antibodies to other autoimmune diseases must be performed together with diagnostic examinations for T1DM. Key words: Type 1 diabetes mellitus, Autoimmune Thyroid Disease, Celiac Disease, Thyroid Peroxidase, Tissue Transglutaminase Antibody.

The role of “latent autoimmune diabetes in adults” in the structure of diabetes mellitus in young people

In the clinical practice of an endocrinologist, verification of the type of diabetes mellitus (DM) in young people is of high clinical significance, since the prescription of treatment depends on this: from the correction of carbohydrate metabolism by a balanced diet to the prescription of oral hypoglycemic drugs and insulin therapy. In rare forms of diabetes mellitus, which include «latent autoimmune diabetes in adults» (LADA), it is not always possible to make a correct diagnosis. This form of diabetes mellitus occupies an intermediate position between type 1 diabetes mellitus and type 2 diabetes mellitus (DM 1 and DM 2) and is often not detected. In this regard, the study of the LADA flow is of great practical importance. Verification of the LADA diagnosis is based on three clinical criteria: adult onset of diabetes; the presence of circulating islet autoantibodies, which distinguishes LADA from T2DM; the absence of an absolute need for insulin when making a diagnosis, which distinguishes LADA from the classic type 1 diabetes mellitus. The main treatment tactics for patients with LADA should be aimed at preserving their own insulin secretion. This requires the timely appointment of insulin therapy. The question of the possibility of using drugs of peripheral action – biguanides and glitazones, which do not cause depletion of β-cells, is discussed, but their effectiveness has not yet been established. The appointment of any secretogens, including sulfonylurea preparations, is contraindicated Quite often, LADA is difficult to diagnose, and the wrong treatment tactics are prescribed. At the moment, there is little data on the effectiveness of different classes of drugs, which leads to further detailed study of this type of diabetes. Currently, there are no special algorithms for LADA treatment

Combination of osteogenesis imperfecta and type 1 diabetes mellitus

Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder accompanied by increased bone fragility. Five types of OI are distinguished on the basis of phenotypic manifestations. OI type 1 is characterized by a reduced amount of normal type 1 collagen and is the mildest form. In addition to the fractures, course of disease can be accompanied by short stature, skeletal deformity and joint hypermobility. Although fracture risk decreases with age, such patients needs regular follow-up with an assessment of bone mineral density (BMD) and, if necessary, correction of therapy to improve the quality of life. Type 1 diabetes mellitus (T1DM) is associated with a decreased BMD, which is mostly attributed to insulin deficiency and hyperglycemia, which also increase the risk of fractures. Achieving and stable maintenance of glycemic targets is often challenging, but it is necessary to exclude hyperglycemia as a factor that further worsens the quality of bone. This paper describes a clinical case of an extremely rare combination of type 1 OI and T1DM, two diseases with a pronounced negative effect on bone tissue. The combination of these pathologies requires special management tactics for such patients to reduce the risk of developing new fractures.