Autoimmune disorders associated with type 1 diabetes mellitus: Diagnosis and implications for diabetes control

Type 1 diabetes is an autoimmune disorder typically presenting in the pediatric population. Individuals with type 1 diabetes have increased prevalence of other autoimmune diseases including autoimmune thyroid disease, celiac disease, and primary adrenal failure. In some patients, a shared genetic susceptibility for these diseases has been demonstrated. Current recommendations are to screen patients with Type 1 diabetes for autoimmune thyroid disease and celiac disease in a proactive manner, while screening for adrenal failure should be done when there is a high index of suspicion. Clinical signs and symptoms, particularly unexplained hypoglycemia, can point to the presence of an associated autoimmune disease. Failure to recognize and treat these disorders can lead to worsening diabetes control. When an individual has multiple autoimmune endocrinopathies, the treating physician should consider the diagnosis of an autoimmune polyglandular syndrome. This review will discuss genetic associations, screening, and treatment strategies in individuals with Type 1 diabetes who are at higher risk for other autoimmune diseases.