OBJECTIVES Type 1 diabetes mellitus is a chronic disorder associated with development of autoimmunity. In this work, we studied the relationship between severity of acidosis at diagnosis and future risk for autoimmunity development in children with type 1 diabetes. METHODS We investigated the presence of associated autoimmunity in 144 children with type 1 diabetes (mean ± standard deviation: age, 12.44±4.76 years; diabetes duration, 4.41±3.70 years). We identified the presence of thyroid disease, celiac disease, autoimmune gastritis and adrenal autoimmunity, and retrospectively reviewed the files for presence of diabetic ketoacidosis at diagnosis. RESULTS Autoimmunity prevalence was 16.7% for thyroid autoimmunity, 9.5% for celiac disease, 5% for gastric autoimmunity and 8.0% for multiple autoimmunities. There were strong associations between severe acidosis at diabetes diagnosis (pH<7.10) and development of thyroid autoimmunity (odds ratio [OR], 5.34; 95% confidence interval [CI], 1.90‒15.1; p<0.001), celiac disease (OR, 5.83; 95% CI, 1.19‒28.6; p=0.013), gastric autoimmunity (OR, 13.1; 95% CI, 1.22‒140; p=0.006) and multiple autoimmunity (OR, 26.7; 95% CI, 2.36‒301; p<0.01). The associations persisted after adjustment for sex, age at diabetes diagnosis, age at assessment, time since diabetes diagnosis and antiglutamic acid decarboxylase autoantibody status. CONCLUSIONS The severity of acidosis at diagnosis is strongly associated with the development of associated autoimmune diseases in children with type 1 diabetes and could act as a predictive factor for multiple autoimmunity development. This association can be either due to effect of acidosis on immune system or to the presence of a more aggressive diabetes endotype.

中文翻译：

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诊断时糖尿病酮症酸中毒的严重程度与 1 型糖尿病儿童的多重自身免疫之间的关联：来自希腊三级中心的一项研究

目的 1 型糖尿病是一种与自身免疫系统发展相关的慢性疾病。在这项工作中，我们研究了 1 型糖尿病儿童诊断时酸中毒的严重程度与未来自身免疫发育风险之间的关系。方法 我们调查了 144 名 1 型糖尿病儿童（平均±标准差：年龄，12.44±4.76 岁；糖尿病病程，4.41±3.70 岁）中相关自身免疫的存在。我们确定了甲状腺疾病、乳糜泻、自身免疫性胃炎和肾上腺自身免疫的存在，并回顾性审查了诊断时存在糖尿病酮症酸中毒的文件。结果 甲状腺自身免疫的自身免疫患病率为 16.7%，乳糜泻为 9.5%，胃自身免疫为 5%，多重自身免疫为 8.0%。糖尿病诊断时的严重酸中毒 (pH<7.10) 与甲状腺自身免疫性疾病的发展（优势比 [OR]，5.34；95% 置信区间 [CI]，1.90-15.1；p<0.001）、乳糜泻（OR , 5.83; 95% CI, 1.19-28.6; p=0.013), 胃自身免疫 (OR, 13.1; 95% CI, 1.22-140; p=0.006) 和多重自身免疫 (OR, 26.7; 95% CI, 301.3) ；p<0.01)。在调整性别、糖尿病诊断年龄、评估年龄、糖尿病诊断时间和抗谷氨酸脱羧酶自身抗体状态后，这种关联仍然存在。结论 诊断时酸中毒的严重程度与 1 型糖尿病儿童相关自身免疫疾病的发展密切相关，并可作为多种自身免疫发展的预测因素。