Association between the severity of diabetic ketoacidosis at diagnosis and multiple autoimmunity in children with type 1 diabetes mellitus: a study from a Greek tertiary center

Abstract: Background Type 1 diabetes mellitus is a chronic disorder that is associated with development of autoimmunity. Objectives We studied in children with type 1 diabetes the relationship between the severity of acidosis at diagnosis and future risk for autoimmunity development. Methods We investigated the presence of associated autoimmunity in 144 children with type 1 diabetes, with mean (± SD) age of 12.44 ± 4.76 years and diabetes duration of 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% of patients had multiple autoimmunity. There were strong associations between severe acidosis at diabetes diagnosis (pH Conclusion 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.