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Tip 1 Diyabette Otoimmün Komorbiditeler ve Metabolik Sonuçlar: Retrospektif Kesitsel Bir Çalışma

Yıl 2026, Cilt: 8 Sayı: 1, 165 - 173, 28.02.2026
https://doi.org/10.52827/hititmedj.1803896
https://izlik.org/JA47XX74YS

Öz

Amaç: Tip 1 diyabetes mellitus (T1DM), sıklıkla otoimmün hastalıklarla birlikte görülen kronik bir metabolik bozukluktur. Bu çalışmanın amacı, özellikle çölyak hastalığı başta olmak üzere, T1DM’ye eşlik eden otoimmün hastalıkların metabolik kontrol ve diyabetik komplikasyonlar üzerindeki etkisini araştırmaktır.
Gereç ve Yöntem: Bu retrospektif kesitsel çalışmada, T1DM’li hastalar arasında otoimmün hastalıkların prevalansı değerlendirildi. Çölyak hastalığı veya Hashimoto hipotiroidisi bulunan T1DM’li hastalarda metabolik regülasyon ve diyabetik komplikasyonlar, yalnızca T1DM’si olan hastalarla karşılaştırıldı.
Bulgular: Toplam 155 T1DM’li hastanın %26.5’inde Hashimoto’ya bağlı otoantikor pozitifliği (n = 41), %7.7’sinde çölyakla ilişkili otoantikor pozitifliği (n = 12) ve %1.9’unda Graves’le ilişkili otoantikor pozitifliği (n = 3) saptandı. Çölyak otoantikorları pozitif olan semptomatik üç hastaya endoskopik duodenum biyopsisi yapıldı ve bir hastada çölyak hastalığı ile uyumlu histopatolojik bulgular tespit edildi. Sekiz seropozitif hasta biyopsiyi reddetti, ancak glutensiz diyet başlandıktan sonra semptomları geriledi. Otoimmün komorbiditesi olan ve olmayan hastalar arasında metabolik kontrol veya diyabetik komplikasyonlar açısından anlamlı bir fark saptanmadı (p > 0.05).
Sonuç: Otoimmün hastalıklar, genel popülasyona kıyasla T1DM’li bireylerde daha sık görülmesine rağmen, glisemik regülasyon üzerinde anlamlı bir etkide bulunmamaktadır. Bununla birlikte, yaşam kalitesini artırmak ve komorbiditelerin yükünü azaltmak amacıyla rutin tarama önerilmektedir.

Kaynakça

  • Ilonen J, Lempainen J, Veijola R. The heterogeneous pathogenesis of type 1 diabetes mellitus. Nat Rev Endocrinol 2019;15(11):635-650.
  • Tuomela K, Levings MK. Genetic engineering of regulatory T cells for treatment of autoimmune disorders including type 1 diabetes. Diabetologia 2024;67(4):611-622.
  • Pisetsky DS. Pathogenesis of autoimmune disease. Nat Rev Nephrol 2023;19(8):509-524.
  • Ebrahimpour Y, Khatami S, Saffar M, et al. A comprehensive review of novel advances in type 1 diabetes mellitus. J Diabetes 2025;17(8):70120.
  • Samuelsson J, Bertilsson R, Bülow E, et al. Autoimmune comorbidity in type 1 diabetes and its association with metabolic control and mortality risk in young people: a population-based study. Diabetologia 2024;67(4):679-689.
  • Chalakova T, Yotov Y, Tzotchev K, et al. Type 1 diabetes mellitus - risk factor for cardiovascular disease morbidity and mortality. Curr Diabetes Rev 2021;17(1):37-54.
  • Ogle GD, Wang F, Haynes A, et al. Global type 1 diabetes prevalence, incidence, and mortality estimates 2025: results from the International Diabetes Federation Atlas, 11th Edition, and the T1D Index Version 3.0. Diabetes Res Clin Pract 2025;225:112277.
  • Popoviciu MS, Kaka N, Sethi Y, Patel N, Chopra H, Cavalu S. Type 1 diabetes mellitus and autoimmune diseases: a critical review of the association and the application of personalized medicine. J Pers Med 2023;13(3):422.
  • Kalra S, Unnikrishnan AG, Sahay R. The hypoglycemic side of hypothyroidism. Indian J Endocrinol Metab 2014;18(1):1–3.
  • Scaramuzza AE, Mantegazza C, Bosetti A, Zuccotti GV. Type 1 diabetes and celiac disease: the effects of gluten-free diet on metabolic control. World J Diabetes 2013;4(4):130-134.
  • Derrou S, El Guendouz F, Benabdelfedil Y, Chakri I, Ouleghzal H, Safi S. The profile of autoimmunity in type 1 diabetes patients. Ann Afr Med 2021;20(1):19-23.
  • Roep BO, Thomaidou S, van Tienhoven R, Zaldumbide A. Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nat Rev Endocrinol 2021;17(3):150-161.
  • American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of Care in Diabetes-2025. Diabetes Care 2025;48(1):59-85.
  • Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology guidelines update: diagnosis and management of celiac disease. Am J Gastroenterol 2023;118(1):59-76.
  • Triolo TM, Armstrong TK, McFann K, et al. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes Care 2011;34(5):1211-1213.
  • Bilginer MC, Faki S, Ozdemir D, et al. Organ-specific autoimmune markers in adult patients with type 1 diabetes mellitus. Int J Clin Pract 2021;75(12):e14842.
  • Giwa AM, Ahmed R, Omidian Z, et al. Current understandings of the pathogenesis of type 1 diabetes: genetics to environment. World J Diabetes 2020;11(1):13-25.
  • Li L, Liu S, Yu J. Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective? Ther Adv Endocrinol Metab 2020;11:2042018820958329.
  • Frommer L, Kahaly GJ. Type 1 diabetes and autoimmune thyroid disease - the genetic link. Front Endocrinol (Lausanne) 2021;12:618213.
  • Sharma H, Sahlot R, Purwar N, et al. Co-existence of type 1 diabetes and other autoimmune ailments in subjects with autoimmune thyroid disorders. Diabetes Metab Syndr 2022;16(2):102405.
  • Aboulaghras S, Piancatelli D, Oumhani K, Balahbib A, Bouyahya A, Taghzouti K. Pathophysiology and immunogenetics of celiac disease. Clin Chim Acta 2022;528:74-83.
  • Tarar ZI, Zafar MU, Farooq U, Basar O, Tahan V, Daglilar E. The progression of celiac disease, diagnostic modalities, and treatment options. J Investig Med High Impact Case Rep 2021;9:23247096211053702.
  • Lindgren M, Norström F, Persson M, et al. Prevalence and predictive factors for celiac disease in children with type 1 diabetes: whom and when to screen? A nationwide longitudinal cohort study of Swedish children. Diabetes Care 2024;47(4):756-760.
  • Mozzillo E, Franceschi R, Di Candia F, et al. The impact of gluten-free diet on growth, metabolic control and quality of life in youth with type 1 diabetes and celiac disease: a systematic review. Diabetes Res Clin Pract 2022;191:110032.
  • Çakmak R, Çaklılı ÖT, Ok AM, et al. Clinical characteristics and development of complications differ between adult-onset and child-adolescent-onset type 1 diabetes: a report from a tertiary medical center in Türkiye. J Diabetes Res 2025;8860118.
  • Bakker SF, Tushuizen ME, von Blomberg ME, Mulder CJ, Simsek S. Type 1 diabetes and celiac disease in adults: glycemic control and diabetic complications. Acta Diabetol 2013;50(3):319-324.
  • Creanza A, Lupoli R, Lembo E, et al. Glycemic control and microvascular complications in adults with type 1 diabetes and long-lasting treated celiac disease: a case-control study. Diabetes Res Clin Pract 2018;143:282-287.

Autoimmune Comorbidities and Metabolic Outcomes in Type 1 Diabetes: A Retrospective Cross-Sectional Study

Yıl 2026, Cilt: 8 Sayı: 1, 165 - 173, 28.02.2026
https://doi.org/10.52827/hititmedj.1803896
https://izlik.org/JA47XX74YS

Öz

Objective: Type 1 diabetes mellitus (T1DM) is a chronic metabolic disorder frequently accompanied by autoimmune diseases. This study aimed to investigate the impact of coexisting autoimmune disorders, particularly celiac disease, on metabolic control and diabetic complications in patients with T1DM.
Material and Methods: This retrospective cross-sectional study evaluated the prevalence of autoimmune diseases among patients with T1DM. Metabolic regulation and diabetic complications in patients with T1DM who also had celiac disease or Hashimoto’s hypothyroidism were compared with those in patients with T1DM alone.
Results: Among 155 patients with T1DM, 26.5% had Hashimoto-related autoantibody positivity (n = 41), 7.7% had celiac-related autoantibody positivity (n = 12), and 1.9% had Graves-related autoantibody positivity (n = 3). Endoscopic duodenal biopsy was performed in three symptomatic patients with positive celiac autoantibodies, and histopathological findings consistent with celiac disease were identified in one patient. Eight seropositive patients declined biopsy but became asymptomatic after starting a gluten-free diet. No significant differences in metabolic control or diabetic complications were observed between patients with or without autoimmune comorbidities (p > 0.05).
Conclusion: Although autoimmune disorders are more prevalent in individuals with T1DM than in the general population, they do not appear to influence glycemic regulation meaningfully. Nonetheless, routine screening remains advisable to enhance quality of life and reduce the burden of comorbidities.

Kaynakça

  • Ilonen J, Lempainen J, Veijola R. The heterogeneous pathogenesis of type 1 diabetes mellitus. Nat Rev Endocrinol 2019;15(11):635-650.
  • Tuomela K, Levings MK. Genetic engineering of regulatory T cells for treatment of autoimmune disorders including type 1 diabetes. Diabetologia 2024;67(4):611-622.
  • Pisetsky DS. Pathogenesis of autoimmune disease. Nat Rev Nephrol 2023;19(8):509-524.
  • Ebrahimpour Y, Khatami S, Saffar M, et al. A comprehensive review of novel advances in type 1 diabetes mellitus. J Diabetes 2025;17(8):70120.
  • Samuelsson J, Bertilsson R, Bülow E, et al. Autoimmune comorbidity in type 1 diabetes and its association with metabolic control and mortality risk in young people: a population-based study. Diabetologia 2024;67(4):679-689.
  • Chalakova T, Yotov Y, Tzotchev K, et al. Type 1 diabetes mellitus - risk factor for cardiovascular disease morbidity and mortality. Curr Diabetes Rev 2021;17(1):37-54.
  • Ogle GD, Wang F, Haynes A, et al. Global type 1 diabetes prevalence, incidence, and mortality estimates 2025: results from the International Diabetes Federation Atlas, 11th Edition, and the T1D Index Version 3.0. Diabetes Res Clin Pract 2025;225:112277.
  • Popoviciu MS, Kaka N, Sethi Y, Patel N, Chopra H, Cavalu S. Type 1 diabetes mellitus and autoimmune diseases: a critical review of the association and the application of personalized medicine. J Pers Med 2023;13(3):422.
  • Kalra S, Unnikrishnan AG, Sahay R. The hypoglycemic side of hypothyroidism. Indian J Endocrinol Metab 2014;18(1):1–3.
  • Scaramuzza AE, Mantegazza C, Bosetti A, Zuccotti GV. Type 1 diabetes and celiac disease: the effects of gluten-free diet on metabolic control. World J Diabetes 2013;4(4):130-134.
  • Derrou S, El Guendouz F, Benabdelfedil Y, Chakri I, Ouleghzal H, Safi S. The profile of autoimmunity in type 1 diabetes patients. Ann Afr Med 2021;20(1):19-23.
  • Roep BO, Thomaidou S, van Tienhoven R, Zaldumbide A. Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nat Rev Endocrinol 2021;17(3):150-161.
  • American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of Care in Diabetes-2025. Diabetes Care 2025;48(1):59-85.
  • Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology guidelines update: diagnosis and management of celiac disease. Am J Gastroenterol 2023;118(1):59-76.
  • Triolo TM, Armstrong TK, McFann K, et al. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes Care 2011;34(5):1211-1213.
  • Bilginer MC, Faki S, Ozdemir D, et al. Organ-specific autoimmune markers in adult patients with type 1 diabetes mellitus. Int J Clin Pract 2021;75(12):e14842.
  • Giwa AM, Ahmed R, Omidian Z, et al. Current understandings of the pathogenesis of type 1 diabetes: genetics to environment. World J Diabetes 2020;11(1):13-25.
  • Li L, Liu S, Yu J. Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective? Ther Adv Endocrinol Metab 2020;11:2042018820958329.
  • Frommer L, Kahaly GJ. Type 1 diabetes and autoimmune thyroid disease - the genetic link. Front Endocrinol (Lausanne) 2021;12:618213.
  • Sharma H, Sahlot R, Purwar N, et al. Co-existence of type 1 diabetes and other autoimmune ailments in subjects with autoimmune thyroid disorders. Diabetes Metab Syndr 2022;16(2):102405.
  • Aboulaghras S, Piancatelli D, Oumhani K, Balahbib A, Bouyahya A, Taghzouti K. Pathophysiology and immunogenetics of celiac disease. Clin Chim Acta 2022;528:74-83.
  • Tarar ZI, Zafar MU, Farooq U, Basar O, Tahan V, Daglilar E. The progression of celiac disease, diagnostic modalities, and treatment options. J Investig Med High Impact Case Rep 2021;9:23247096211053702.
  • Lindgren M, Norström F, Persson M, et al. Prevalence and predictive factors for celiac disease in children with type 1 diabetes: whom and when to screen? A nationwide longitudinal cohort study of Swedish children. Diabetes Care 2024;47(4):756-760.
  • Mozzillo E, Franceschi R, Di Candia F, et al. The impact of gluten-free diet on growth, metabolic control and quality of life in youth with type 1 diabetes and celiac disease: a systematic review. Diabetes Res Clin Pract 2022;191:110032.
  • Çakmak R, Çaklılı ÖT, Ok AM, et al. Clinical characteristics and development of complications differ between adult-onset and child-adolescent-onset type 1 diabetes: a report from a tertiary medical center in Türkiye. J Diabetes Res 2025;8860118.
  • Bakker SF, Tushuizen ME, von Blomberg ME, Mulder CJ, Simsek S. Type 1 diabetes and celiac disease in adults: glycemic control and diabetic complications. Acta Diabetol 2013;50(3):319-324.
  • Creanza A, Lupoli R, Lembo E, et al. Glycemic control and microvascular complications in adults with type 1 diabetes and long-lasting treated celiac disease: a case-control study. Diabetes Res Clin Pract 2018;143:282-287.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Endokrinoloji
Bölüm Araştırma Makalesi
Yazarlar

Burak Menekşe 0000-0002-1010-110X

Burçak Cavnar Helvacı 0000-0002-8356-4463

Enes Üçgül 0000-0002-6858-751X

Erman Çakal 0000-0003-4455-7276

Gönderilme Tarihi 15 Ekim 2025
Kabul Tarihi 10 Şubat 2026
Yayımlanma Tarihi 28 Şubat 2026
DOI https://doi.org/10.52827/hititmedj.1803896
IZ https://izlik.org/JA47XX74YS
Yayımlandığı Sayı Yıl 2026 Cilt: 8 Sayı: 1

Kaynak Göster

AMA 1.Menekşe B, Cavnar Helvacı B, Üçgül E, Çakal E. Autoimmune Comorbidities and Metabolic Outcomes in Type 1 Diabetes: A Retrospective Cross-Sectional Study. Hitit Medical Journal. 2026;8(1):165-173. doi:10.52827/hititmedj.1803896