Clinical Indicators of Risk for Addison Disease in Patients With T1D
Risk for premature death from adrenal insufficiency in patients with Addison disease is increased with comorbid type 1 diabetes, indicating a need for early identification and awareness.
The need for the medical treatment of thyroid disease, development of severe infections, prescription of glucagon for hypoglycemia, and occurrence of diabetic retinopathy occur more frequently in individuals with type 1 diabetes (T1D) who are subsequently diagnosed with Addison disease (AD), according to study findings published in The Journal of Clinical Endocrinology & Metabolism.
Individuals with autoimmune disorders like T1D are at a higher risk of developing a second autoimmune condition, including AD. While concomitant T1D and AD is rare, the risk of developing AD in patients with T1D is more than 10 times greater compared with the general population. The researchers conducted a nationwide observational matched-cohort study to determine whether there were any early clinical indicators of the development of AD in adults with T1D. Using data from Swedish national registries, the investigators identified 66 patients with T1D and concomitant AD between 1998 to 2013, and each case was matched with 5 controls with T1D alone (n = 330). Clinical data including drug prescriptions were assessed at baseline and before a diagnosis of AD.
Results showed that prior to baseline, patients with T1D and AD had a higher frequency of thyroid and/or antithyroid drug prescription (9.1%) vs the control group (1.8%). Prior to a diagnosis of AD, patients also had a greater frequency of diabetic retinopathy (12.1% vs 2.1% in control group), infections that required hospitalization (16.7% vs 2.1% in control group), thyroid/antithyroid drug prescription (28.8% vs 7.0% in control group), and glucagon prescription (18.2% vs 6.4% in control group). Glycated hemoglobin was similar between the groups prior to baseline or AD diagnosis.
The researchers concluded that their results “identified early clinical indicators that should raise physician awareness and trigger biochemical evaluation of AD among patients with [T1D].”
Chantzichristos D, Persson A, Miftaraj M, Eliasson B, Svensson AM, Johannsson G. Early clinical indicators of Addison's disease in adults with type 1 diabetes: a nationwide, observational, cohort study [published online November 21, 2018]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-02064