Prevalence of Autoimmune Comorbidities in Type-1 Diabetes: A Hidden Burden in the Pediatric Population

Objectives: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder frequently associated with other autoimmune conditions such as autoimmune thyroid disease and coeliac disease, largely due to shared human leukocyte antigen susceptibility and immune dysregulation. This study evaluates the prevalence of these comorbidities in children and adolescents with T1DM attending a tertiary endocrine clinic in North India. Material and Methods: We conducted a cross-sectional observational study, which included 137 patients aged 1–18 years with confirmed T1DM on regular follow-up. Screening for coeliac disease was performed using serum immunoglobulin A anti-tissue transglutaminase antibodies, with duodenal biopsy for seropositive patients as per ESPGHAN criteria. Thyroid function tests (thyroid-stimulating hormone, free T4) and anti-thyroid peroxidase antibodies were used to diagnose autoimmune hypothyroidism. Patients underwent autoimmune screening at diagnosis and annually thereafter as per institutional protocol. Results: Of 137 patients, 13 children (9.5%; 95% confidence interval [CI]: 4.6–14.4%) had biopsy-confirmed coeliac disease, and 15 (10.9%; 95% CI: 5.7–16.1%) had autoimmune hypothyroidism. Two patients (1.46%) had both conditions. Overall, 28 children (20.4%) had at least one autoimmune comorbidity. Most coeliac disease cases were detected on routine screening rather than clinical suspicion. Conclusion: As per our center’s protocol, patients undergo routine screening for associated autoimmune comorbidities at diagnosis and annually thereafter. Delayed identification can result in significant complications, including growth retardation, poor glycemic control, and increased morbidity. Therefore, systematic autoimmune screening should be an integral part of standard T1DM care to enable early detection, timely management, and improved long-term outcomes and quality of life.