W Hunger-Battefeld

Diabetic foot syndrome and renal function in type 1 and 2 diabetes mellitus show close association

BACKGROUND Diabetic nephropathy and diabetic foot syndrome (DFS) are two major complications of diabetes. Surprisingly, little is known of a potential relationship between renal function and the development of DFS in patients with preterminal renal insufficiency. A retrospective cohort study at a single tertiary university centre caring for a large collective of patients with type 1 and 2 diabetes was performed. Patients and methods. All patients with type 1 or 2 diabetes from 1989 to 2007 on the electronic patient sheet who had standardized food examination, albuminuria and serum creatinine were analysed. A total number of 899 patients with type 1 and 4007 individuals with type 2 diabetes were studied. Estimated glomerular filtration rate (eGFR) was calculated according to the modified equation 7 MDRD formula. Patients were grouped into the chronic kidney disease (CKD) stages according to the eGFR and presence of albuminuria. DFS was classified according to Wagner as well as Armstrong stages. RESULTS Forty-six patients (5.1%) of 899 patients with type 1 diabetes have active or a history of DFS. Patients with type 1 diabetes and DSF had significantly higher serum creatinine levels, lower eGFR, higher systolic blood pressure and higher HbA1c levels compared to those without DFS. There was a significant negative correlation between eGFR and the presence of DFS in patients with type 1 diabetes (r = -0.155, P < 0.01). In type 1 diabetes patients, there was a significant negative correlation (Spearman test) between eGFR and Wagner stages (r = -0.218, P = 0.01) as well as Armstrong stages (r = -0.255, P = 0.01). Multiple logistic regression analysis revealed a significant association between the presence of DFS and eGFR (odds ratio 0.696 per 10 ml/min increase, 95% confidence interval 0.627-0.773, P < 0.001). A total of 532 type 2 patients from 4007 patients had DFS (13.7%). Compared with type 2 patients without DFS, those with DFS were significantly older (P < 0.005), exhibited a higher HbA1c, had a longer duration of diabetes (P < 0.005), higher serum creatinine levels (P < 0.005) and a lower eGFR (P < 0.005). There was a significant negative correlation between the Wagner stages and eGFR (r = -0.104, P < 0.01) as well as Armstrong stages and eGFR (r = -0.125, P < 0.01) in all patients with type 2 diabetes (Spearman test). Multiple logistic regression analysis revealed a significant association between the presence of DFS and eGFR (odds ratio 0.873 per 10 ml/min increase, 95% confidence interval 0.842-0.904, P < 0.001). There were also significant associations between DFS and duration of diabetes as well as diastolic blood pressure. In addition, the Jonckheere-Terpstra test confirmed the decrease of eGFR with increasing Wagner and Armstrong stages in patients with type 2 diabetes. Smoking was not associated with a higher prevalence of DFS in type 1 and 2 diabetic patients. CONCLUSION There was a strong association between the degree of renal function impairment and DFS in this observational study. Data show that diabetics with DFS undergo a higher incidence of amputation; thus, it should be recommended that diabetic patients with renal insufficiency should be regularly screened for the presence of DFS.

Hemoglobin Concentrations Are Closely Linked to Renal Function in Patients with Type 1 or 2 Diabetes Mellitus

Background/Aims: It has been reported that anemia is more common in patients with diabetes mellitus, and that it occurs early in the disease process. Methods: In this study, we evaluated hemoglobin (Hb) values of patients with diabetes type 1 or 2 from a large collective receiving care from a tertiary center. A total of 751 patients with type 1 diabetes and 3,306 patients with type 2 were studied. Correlations were calculated for Hb with the following parameters: metabolic control (HbA1c and blood glucose), renal function [estimated glomerular filtration rate (eGFR), serum creatinine, albuminuria, proteinuria], blood leukocytes, duration of diabetes and use of ACE inhibitors/AT1-receptor antagonists. Results: 17% of patients with type 1 diabetes and 14% of those with type 2 had anemia [defined as an Hb <8.5 mmol/l (<13.68 g/dl) in men and <7.5 mmol/l (<12.07 g/dl) in women). There was a close positive correlation between Hb and eGFR, and a negative correlation with albuminuria and proteinuria. These close associations were also confirmed with linear regression analysis. A significant negative correlation was observed between serum creatinine levels and Hb. There was no negative correlation between actual Hb and mean HbA1c in the individual follow-up periods. No correlation was found between blood glucose (morning and postprandial blood glucose) and Hb. Blood leukocyte numbers, as a parameter of systemic inflammation, were not correlated with Hb. The use of ACE inhibitors/AT1-receptor antagonists had no adverse effect on Hb in our study cohort. Conclusion: No negative effects of metabolic control on Hb could be demonstrated in this study.

Prevalence of polyglandular autoimmune syndrome in patients with diabetes mellitus type 1

ZusammenfassungHintergrund und Ziel:Bei Patienten mit Diabetes mellitus Typ 1 treten gehäuft weitere endokrine Autoimmunerkrankungen (AIEK) auf. In dieser Studie wurden die Häufigkeit pathologischer Autoantikörper-(AAK-)Befunde und das Auftreten einer klinisch manifesten endokrinen AIEK (Hypophysitis, Adrenalitis, Thyreopathie, Perniziosa, Sprue) bei Patienten mit Diabetes mellitus Typ 1 im Verlauf 1 Jahres untersucht.Patienten und Methodik:Bei 139 Patienten mit Diabetes mellitus Typ 1 (Alter 44 ± 14 Jahre; Diabetesmanifestationsalter 26 ± 15 Jahre; Diabetesdauer 18 ± 12 Jahre; Body-Mass-Index 26 ± 4 kg/m2; HbA1c 7,5% ± 1,1% [Normalbereich 4,4–5,9%]), die in einer Universitätsklinik behandelt wurden, erfolgten ein AAK-Screening und bei pathologischem AAK-Titer eine Diagnostik hinsichtlich o.g. AIEK. Eine Befundkontrolle wurde 1 Jahr später durchgeführt.Ergebnisse:2003 zeigten 63% der Patienten mit Diabetes mellitus Typ 1 mindestens einen pathologischen AAK-Titer (2004: 60%) Bei 32% waren erhöhte AAK-Titer klinisch nicht relevant. Bei 31% der Patienten lag 2003 neben dem Typ-1-Diabetes mindestens eine weitere therapiepflichtige AIEK vor (2004: +3,6%): Dabei zeigten 22,3% zwei AIEK (2004: +2,2%) und 8,6% ≥ 3 AIEK (2004: +1,5%). Folgende positive AAK-Titer/Erkrankungsprävalenzen lagen vor (Vergleich 2004): positive Schilddrüsen-AAK: 47,5% (–0,7%)/Autoimmunthyreoiditis 24,5% (+2,8%) bzw. Morbus Basedow 4,3% (+0,7%), Nebennierenrinden-AAK 0,7% (+1,5%)/Morbus Addison 1,4% (±0), Gliadin-AAK bzw. Gewebsglutaminase-IgA positiv: 18,7% (–5,0%)/Sprue 1,4% (+0,8%), Parietalzellantikörper positiv: 15,8% (+7,2%)/Perniziosa 7,2% (+1,4%), Hypophysitis 0,7% (±0), Hypogonadismus 0,7% (±0). Alle Neuerkrankungen 2004 zeigten bereits im Vorjahr einen mindestens zehnfach erhöhten AAK-Titer. Zwischen Patienten mit versus ohne polyglanduläres Autoimmunsyndrom (PAS) fanden sich keine signifikanten Unterschiede bezüglich Alter (43 ± 14 vs. 46 ± 13 Jahre), Diabetesdauer (17 ± 13 vs. 18 ± 12 Jahre) und HbA1c (7,3% ± 0,9% vs. 7,6% ± 1,1%).Schlussfolgerung:In dieser Untersuchung wies mehr als die Hälfte der Patienten mit Diabetes mellitus Typ 1 mindestens einen weiteren pathologischen AAK-Titer auf, der jedoch keinen sicheren Rückschluss auf eine klinisch relevante AIEK zuließ. Bei 31% der Patienten lag mindestens eine weitere therapiepflichtige AIEK vor (Prävalenzanstieg um 3,6% innerhalb 1 Jahres). Bei Patienten mit Diabetes mellitus Typ 1 sollte an ein PAS gedacht werden. Eine Thyreopathie war am häufigsten und zeigte einen Prävalenzanstieg um 3,5% innerhalb 1 Jahres.AbstractBackground and Purpose:The aim of this study was to examine the prevalence of autoimmune antibodies (autoimmune hypophysitis, adrenalitis, thyropathy, pernicious anemia, celiac disease) and clinically relevant endocrine autoimmune disease (AIEK) in patients with type 1 diabetes in the course of 1 year.Patients and Methods:Antibody screening was performed in 139 diabetic patients (age 44 ± 14 years; years since diagnosis 26 ± 15 years; duration of diabetes 18 ± 12 years; body mass index 26 ± 4 kg/m2; HbA1c 7.5% ± 1.1% [normal range 4.4–5.9%]) who completed a routine clinic visit in 2003. Patients with pathologically increased antibody titers were further examined regarding the clinically relevant AIEKs. Reexamination was performed 1 year later.Results:In 2003, 63% of diabetic patients showed at least one pathologically increased antibody titer (2004: 60%). In 32% of the patients, increased antibody titers were clinically inapparent. Apart from diabetes mellitus type 1, in 2003, 31% suffered from other AIEK requiring therapy (2004: +3.6%): 22.3% harbored two additional AIEKs (2004: +2.2%) and 8.6% even ≥ 3 AIEKs (2004: +1.5%). The following pathologically increased antibody titers/prevalences of clinically relevant AIEKs were found (in comparison with 2004): increased antithyroid autoantibodies: 47.5% (–0.7%)/autoimmune thyroiditis 24.5% (+2.8%) and Graves’ disease 4.3% (+0.7%), respectively; adrenal cortex autoantibodies 0.7% (+1.5%)/Addison’s disease 1.4% (±0), gliadin peptide antibodies and IgA to tissue transglutaminase, respectively: 18.7% (–5.0%)/celiac disease 1.4% (+0.8%), parietal cell antibodies: 15.8% (+7.2%)/pernicious anemia 7.2% (+1.4%), hypophysitis 0.7% (±0), hypogonadism 0.7% (±0). All new AIEK manifestations in 2004 had had an at least tenfold increased antibody titer in 2003. Comparing patients with and without polyglandular autoimmune syndrome (PAS), no difference in age (43 ± 14 vs. 46 ± 13 years), duration of diabetes (17 ± 13 vs. 18 ± 12 years), and HbA1c (7.3% ± 0.9% vs. 7.6% ± 1.1%) could be found.Conclusion:In this study, more than half of the patients with diabetes mellitus type 1 had at least one pathologically increased antibody titer apart from diabetes without clinical sign of an additional AIEK. 31% of patients with increased antibodies presented with symptoms of another AIEK (increase by 3.6% within 1 year). Patients with diabetes mellitus type 1 should be screened for other AIEKs. Thyropathy had the greatest prevalence and increased by 3.5% within 1 year’s time.

Prävalenz eines polyglandulären Autoimmunsyndroms bei Patienten mit Diabetes mellitus Typ 1

ZusammenfassungHintergrund und Ziel:Bei Patienten mit Diabetes mellitus Typ 1 treten gehäuft weitere endokrine Autoimmunerkrankungen (AIEK) auf. In dieser Studie wurden die Häufigkeit pathologischer Autoantikörper-(AAK-)Befunde und das Auftreten einer klinisch manifesten endokrinen AIEK (Hypophysitis, Adrenalitis, Thyreopathie, Perniziosa, Sprue) bei Patienten mit Diabetes mellitus Typ 1 im Verlauf 1 Jahres untersucht.Patienten und Methodik:Bei 139 Patienten mit Diabetes mellitus Typ 1 (Alter 44 ± 14 Jahre; Diabetesmanifestationsalter 26 ± 15 Jahre; Diabetesdauer 18 ± 12 Jahre; Body-Mass-Index 26 ± 4 kg/m2; HbA1c 7,5% ± 1,1% [Normalbereich 4,4–5,9%]), die in einer Universitätsklinik behandelt wurden, erfolgten ein AAK-Screening und bei pathologischem AAK-Titer eine Diagnostik hinsichtlich o.g. AIEK. Eine Befundkontrolle wurde 1 Jahr später durchgeführt.Ergebnisse:2003 zeigten 63% der Patienten mit Diabetes mellitus Typ 1 mindestens einen pathologischen AAK-Titer (2004: 60%) Bei 32% waren erhöhte AAK-Titer klinisch nicht relevant. Bei 31% der Patienten lag 2003 neben dem Typ-1-Diabetes mindestens eine weitere therapiepflichtige AIEK vor (2004: +3,6%): Dabei zeigten 22,3% zwei AIEK (2004: +2,2%) und 8,6% ≥ 3 AIEK (2004: +1,5%). Folgende positive AAK-Titer/Erkrankungsprävalenzen lagen vor (Vergleich 2004): positive Schilddrüsen-AAK: 47,5% (–0,7%)/Autoimmunthyreoiditis 24,5% (+2,8%) bzw. Morbus Basedow 4,3% (+0,7%), Nebennierenrinden-AAK 0,7% (+1,5%)/Morbus Addison 1,4% (±0), Gliadin-AAK bzw. Gewebsglutaminase-IgA positiv: 18,7% (–5,0%)/Sprue 1,4% (+0,8%), Parietalzellantikörper positiv: 15,8% (+7,2%)/Perniziosa 7,2% (+1,4%), Hypophysitis 0,7% (±0), Hypogonadismus 0,7% (±0). Alle Neuerkrankungen 2004 zeigten bereits im Vorjahr einen mindestens zehnfach erhöhten AAK-Titer. Zwischen Patienten mit versus ohne polyglanduläres Autoimmunsyndrom (PAS) fanden sich keine signifikanten Unterschiede bezüglich Alter (43 ± 14 vs. 46 ± 13 Jahre), Diabetesdauer (17 ± 13 vs. 18 ± 12 Jahre) und HbA1c (7,3% ± 0,9% vs. 7,6% ± 1,1%).Schlussfolgerung:In dieser Untersuchung wies mehr als die Hälfte der Patienten mit Diabetes mellitus Typ 1 mindestens einen weiteren pathologischen AAK-Titer auf, der jedoch keinen sicheren Rückschluss auf eine klinisch relevante AIEK zuließ. Bei 31% der Patienten lag mindestens eine weitere therapiepflichtige AIEK vor (Prävalenzanstieg um 3,6% innerhalb 1 Jahres). Bei Patienten mit Diabetes mellitus Typ 1 sollte an ein PAS gedacht werden. Eine Thyreopathie war am häufigsten und zeigte einen Prävalenzanstieg um 3,5% innerhalb 1 Jahres.AbstractBackground and Purpose:The aim of this study was to examine the prevalence of autoimmune antibodies (autoimmune hypophysitis, adrenalitis, thyropathy, pernicious anemia, celiac disease) and clinically relevant endocrine autoimmune disease (AIEK) in patients with type 1 diabetes in the course of 1 year.Patients and Methods:Antibody screening was performed in 139 diabetic patients (age 44 ± 14 years; years since diagnosis 26 ± 15 years; duration of diabetes 18 ± 12 years; body mass index 26 ± 4 kg/m2; HbA1c 7.5% ± 1.1% [normal range 4.4–5.9%]) who completed a routine clinic visit in 2003. Patients with pathologically increased antibody titers were further examined regarding the clinically relevant AIEKs. Reexamination was performed 1 year later.Results:In 2003, 63% of diabetic patients showed at least one pathologically increased antibody titer (2004: 60%). In 32% of the patients, increased antibody titers were clinically inapparent. Apart from diabetes mellitus type 1, in 2003, 31% suffered from other AIEK requiring therapy (2004: +3.6%): 22.3% harbored two additional AIEKs (2004: +2.2%) and 8.6% even ≥ 3 AIEKs (2004: +1.5%). The following pathologically increased antibody titers/prevalences of clinically relevant AIEKs were found (in comparison with 2004): increased antithyroid autoantibodies: 47.5% (–0.7%)/autoimmune thyroiditis 24.5% (+2.8%) and Graves’ disease 4.3% (+0.7%), respectively; adrenal cortex autoantibodies 0.7% (+1.5%)/Addison’s disease 1.4% (±0), gliadin peptide antibodies and IgA to tissue transglutaminase, respectively: 18.7% (–5.0%)/celiac disease 1.4% (+0.8%), parietal cell antibodies: 15.8% (+7.2%)/pernicious anemia 7.2% (+1.4%), hypophysitis 0.7% (±0), hypogonadism 0.7% (±0). All new AIEK manifestations in 2004 had had an at least tenfold increased antibody titer in 2003. Comparing patients with and without polyglandular autoimmune syndrome (PAS), no difference in age (43 ± 14 vs. 46 ± 13 years), duration of diabetes (17 ± 13 vs. 18 ± 12 years), and HbA1c (7.3% ± 0.9% vs. 7.6% ± 1.1%) could be found.Conclusion:In this study, more than half of the patients with diabetes mellitus type 1 had at least one pathologically increased antibody titer apart from diabetes without clinical sign of an additional AIEK. 31% of patients with increased antibodies presented with symptoms of another AIEK (increase by 3.6% within 1 year). Patients with diabetes mellitus type 1 should be screened for other AIEKs. Thyropathy had the greatest prevalence and increased by 3.5% within 1 year’s time.

PP063. Carotid artery stiffness and elasticity in gestational diabetes

INTRODUCTION Gestational diabetes (GMD) is gaining in importance in prenatal care due to its increasing prevalence. These women do have a higher risk for disrupted elasticity and stiffening of the carotid artery. Aim of this study was to assess carotid intima media thickness (IMT) and vessel wall changes during pregnancy and postpartum. METHODS IMT and vessel wall parameters of the carotid artery were evaluated with high resolution ultrasound during pregnancy and postpartum on 84 women with gestational diabetes and 106 gestational age matched controls. RESULTS Carotid elasticity (mean (%)±SD) was significantly lower in women with GDM than healthy pregnant women (9.48 (103/kPa)±3.21 vs. 11.01±3.17, p<0.047), whereas blood pressure independent ß-stiffness (mean±SD) was significantly increased in women with GDM (6.08±3.15 vs. 4.68±1.57; p=0.007). Pregnancies complicated by GDM had higher mean arterial pressure then matched controls (93±12 vs. 86±10mmHg, p<0.015). Postpartum, both groups did not show any significant changes. CONCLUSION Carotid stiffening and rigidity is present in gestational diabetes mellitus during pregnancy and shows postpartal recovery. Therefore GDM dependent vessel wall changes seem to be only temporary and not pre-existing.

Prävalenz eines polyglandulären Autoimmunsyndroms bei Patienten mit Diabetes mellitus Typ 1@@@Prevalence of Polyglandular Autoimmune Syndrome in Patients with Diabetes Mellitus Type 1

ZusammenfassungHintergrund und Ziel:Bei Patienten mit Diabetes mellitus Typ 1 treten gehäuft weitere endokrine Autoimmunerkrankungen (AIEK) auf. In dieser Studie wurden die Häufigkeit pathologischer Autoantikörper-(AAK-)Befunde und das Auftreten einer klinisch manifesten endokrinen AIEK (Hypophysitis, Adrenalitis, Thyreopathie, Perniziosa, Sprue) bei Patienten mit Diabetes mellitus Typ 1 im Verlauf 1 Jahres untersucht.Patienten und Methodik:Bei 139 Patienten mit Diabetes mellitus Typ 1 (Alter 44 ± 14 Jahre; Diabetesmanifestationsalter 26 ± 15 Jahre; Diabetesdauer 18 ± 12 Jahre; Body-Mass-Index 26 ± 4 kg/m2; HbA1c 7,5% ± 1,1% [Normalbereich 4,4–5,9%]), die in einer Universitätsklinik behandelt wurden, erfolgten ein AAK-Screening und bei pathologischem AAK-Titer eine Diagnostik hinsichtlich o.g. AIEK. Eine Befundkontrolle wurde 1 Jahr später durchgeführt.Ergebnisse:2003 zeigten 63% der Patienten mit Diabetes mellitus Typ 1 mindestens einen pathologischen AAK-Titer (2004: 60%) Bei 32% waren erhöhte AAK-Titer klinisch nicht relevant. Bei 31% der Patienten lag 2003 neben dem Typ-1-Diabetes mindestens eine weitere therapiepflichtige AIEK vor (2004: +3,6%): Dabei zeigten 22,3% zwei AIEK (2004: +2,2%) und 8,6% ≥ 3 AIEK (2004: +1,5%). Folgende positive AAK-Titer/Erkrankungsprävalenzen lagen vor (Vergleich 2004): positive Schilddrüsen-AAK: 47,5% (–0,7%)/Autoimmunthyreoiditis 24,5% (+2,8%) bzw. Morbus Basedow 4,3% (+0,7%), Nebennierenrinden-AAK 0,7% (+1,5%)/Morbus Addison 1,4% (±0), Gliadin-AAK bzw. Gewebsglutaminase-IgA positiv: 18,7% (–5,0%)/Sprue 1,4% (+0,8%), Parietalzellantikörper positiv: 15,8% (+7,2%)/Perniziosa 7,2% (+1,4%), Hypophysitis 0,7% (±0), Hypogonadismus 0,7% (±0). Alle Neuerkrankungen 2004 zeigten bereits im Vorjahr einen mindestens zehnfach erhöhten AAK-Titer. Zwischen Patienten mit versus ohne polyglanduläres Autoimmunsyndrom (PAS) fanden sich keine signifikanten Unterschiede bezüglich Alter (43 ± 14 vs. 46 ± 13 Jahre), Diabetesdauer (17 ± 13 vs. 18 ± 12 Jahre) und HbA1c (7,3% ± 0,9% vs. 7,6% ± 1,1%).Schlussfolgerung:In dieser Untersuchung wies mehr als die Hälfte der Patienten mit Diabetes mellitus Typ 1 mindestens einen weiteren pathologischen AAK-Titer auf, der jedoch keinen sicheren Rückschluss auf eine klinisch relevante AIEK zuließ. Bei 31% der Patienten lag mindestens eine weitere therapiepflichtige AIEK vor (Prävalenzanstieg um 3,6% innerhalb 1 Jahres). Bei Patienten mit Diabetes mellitus Typ 1 sollte an ein PAS gedacht werden. Eine Thyreopathie war am häufigsten und zeigte einen Prävalenzanstieg um 3,5% innerhalb 1 Jahres.AbstractBackground and Purpose:The aim of this study was to examine the prevalence of autoimmune antibodies (autoimmune hypophysitis, adrenalitis, thyropathy, pernicious anemia, celiac disease) and clinically relevant endocrine autoimmune disease (AIEK) in patients with type 1 diabetes in the course of 1 year.Patients and Methods:Antibody screening was performed in 139 diabetic patients (age 44 ± 14 years; years since diagnosis 26 ± 15 years; duration of diabetes 18 ± 12 years; body mass index 26 ± 4 kg/m2; HbA1c 7.5% ± 1.1% [normal range 4.4–5.9%]) who completed a routine clinic visit in 2003. Patients with pathologically increased antibody titers were further examined regarding the clinically relevant AIEKs. Reexamination was performed 1 year later.Results:In 2003, 63% of diabetic patients showed at least one pathologically increased antibody titer (2004: 60%). In 32% of the patients, increased antibody titers were clinically inapparent. Apart from diabetes mellitus type 1, in 2003, 31% suffered from other AIEK requiring therapy (2004: +3.6%): 22.3% harbored two additional AIEKs (2004: +2.2%) and 8.6% even ≥ 3 AIEKs (2004: +1.5%). The following pathologically increased antibody titers/prevalences of clinically relevant AIEKs were found (in comparison with 2004): increased antithyroid autoantibodies: 47.5% (–0.7%)/autoimmune thyroiditis 24.5% (+2.8%) and Graves’ disease 4.3% (+0.7%), respectively; adrenal cortex autoantibodies 0.7% (+1.5%)/Addison’s disease 1.4% (±0), gliadin peptide antibodies and IgA to tissue transglutaminase, respectively: 18.7% (–5.0%)/celiac disease 1.4% (+0.8%), parietal cell antibodies: 15.8% (+7.2%)/pernicious anemia 7.2% (+1.4%), hypophysitis 0.7% (±0), hypogonadism 0.7% (±0). All new AIEK manifestations in 2004 had had an at least tenfold increased antibody titer in 2003. Comparing patients with and without polyglandular autoimmune syndrome (PAS), no difference in age (43 ± 14 vs. 46 ± 13 years), duration of diabetes (17 ± 13 vs. 18 ± 12 years), and HbA1c (7.3% ± 0.9% vs. 7.6% ± 1.1%) could be found.Conclusion:In this study, more than half of the patients with diabetes mellitus type 1 had at least one pathologically increased antibody titer apart from diabetes without clinical sign of an additional AIEK. 31% of patients with increased antibodies presented with symptoms of another AIEK (increase by 3.6% within 1 year). Patients with diabetes mellitus type 1 should be screened for other AIEKs. Thyropathy had the greatest prevalence and increased by 3.5% within 1 year’s time.